Appeal letters for surgical denials

 

 appeals to specialists 


Weight Related Surgical Denials - Lap Band, Gastric Bypass and Abdominoplasty

Don't pay hundreds of dollars in consulting or attorney's fees.  Go To Appeal Letter Order Form

Many health plans consider paying for weight related surgical procedures as being cosmetic or not medically necessary.  However, these procedures often are performed to alleviate a patient from real medical symptoms.   

  1. For most appeals, you are going to need the assistance from your physician to provide statements of medical necessity.

  2. You must also obtain an authorization where required by your health plan.

  3. Your symptoms/diagnosis required for the surgical procedure must be specific and detailed by your physician in your medical chart.

  4. Denials could be properly appealed depending upon the support by your physician proving medical necessity and the focus of your argument within the appeal letter.

How do you combat a surgical denial? The following steps may help.

  1. Review the denial with your policy booklet and verify that their denial is justified. If their reason for denial is unclear, call the customer service unit at the health plan for a more descriptive explanation. Record your conversation and document the name of the individual you spoke with for future reference.

  2. Does your health plan cover the specific surgical procedure and did you abide by the policy and limitations by the plan?

  3. If you received an authorization, this will help.  However, if  you are appealing to get this procedure authorized, you must still prove medical necessity.

  • Appeal the denial yourself by using one of our Appeal Letters.  Our Appeal Letters have been used by actual medical providers and provide arguments embedded within the Appeal Letter to make your case to the health plan to overturn your denial.  To review available appeal letters, click here and review the List of Available Appeal Letters for Weight Related Surgical Denials.

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Health Symphony provides information as a general resource and does not guarantee any results, expressed or implied, obtained from its use.