Here is an example of an appeal letter.
February 15,
1999
Dear Review Committee:
This letter comes in response to my recent denial for surgery. I am writing this
letter to appeal your
decision. I will use this forum to tell you about myself and my history as well
as educate you in the
arena of Weight Loss Surgery.
I am a 36-year-old morbidly obese wife and mother of three children. It is my
dream to be able to go on bike rides, hikes, walks, even amusement park rides
with my kids. Things the "normal" person takes for granted. When I walk from my
car to my office, my heart is pounding and racing. I am so out of breath
people stare. My lower back is so painful, I cannot walk for long periods, I
have to stop and rest for a bit.
I suffer from severe acid reflux disease, incontinence, severe chronic lower
back pain, and depression. It has been documented that all of these problems can
be helped, if not cured, by losing weight. I have tried many, many diets. (I
have included my diet history with this letter.) The most weight I was able to
lose was 30 pounds. My BMI is 44, that makes gastric bypass surgery a medical
necessity.
I am very well educated in the area of Gastric Bypass Surgery. I have been
researching for months. I have been going to support group meetings where the
participants are mostly postoperative gastric bypass surgery patients. I also
belong to a support group mailing list of over 600 members, both post-op and
pre-op. I have learned a tremendous amount from all these people. I know what
this surgery is and what it will do for me and my life. That is why I want and
need to have this surgery. And after reviewing my family medical history, you
will probably agree with me that to not have this surgery will surely lead to
more severe medical problems in the future.
Here is my family medical history:
Grandmother on my mother's side died of a massive heart attack at age of 42. One
of my mother's brothers died of a massive heart attack while waterskiing at age
32. Another of my mother's brother's had a triple bypass at age 37. My mother
has coronary vascular disease. My Grandmother on my father's side had diabetes,
and died of heart failure at age 67. Obesity runs on both sides of my family.
My PCP, my surgeon, and my Psychologist all agree that this procedure is the
right option for me. I also agree with them. I want this surgery. It will save
my life, and give me back what life I have left. I will not give up on getting
this procedure approved. I will keep coming back. However, if this surgery
request is denied a second time, I will not be coming back alone. I have already
spoken with an attorney, who will be representing me if the need be. So, I beg
you, please approve this surgery... I will not go away.
There has been a lot of misconception about this surgery, so I have take the
liberty of going to the American Society for Bariatric Surgery (ASBS) website
and gathered this information for you.
Clinically severe (Morbid) obesity correlates with a Body Mass Index (BMI) of 40
kg/m2 (or higher) or with being 100 pounds overweight. Being overweight is
associated with real physical problems, which are now well recognized. The most
obvious is an increased mortality rate directly related to weight increase.
Obesity is dangerous to health because of the associated increased prevalence of
cardiovascular risk factors such as hypertension, diabetes mellitus,
hypertriglyceridemia, hyperinsulinemia and low levels of high-density
lipoprotein (HDL) cholesterol. Cardiovascular risk factors are reduced
significantly by sustained weight reduction. Data from the Framingham study
support the estimate that a ten percent reduction in body weight corresponds to
a twenty percent reduction in the risk of developing coronary heart disease.
The risk for diabetes has been reported to be about twofold in the mildly obese,
fivefold in moderately obese and tenfold in severely obese persons. The risk of
developing diabetes also increases with age, if a family history is present and
if the obesity is central.
Surgical treatment is medically necessary because it is the only proven method
of achieving long term weight control for the severely obese. Surgical treatment
is not a cosmetic procedure. Surgical treatment of severe obesity does not
involve the removal of adipose tissue (fat) by suction or excision. Bariatric
surgery involves reducing the size of the gastric reservoir, with or without a
degree of associated malabsorption. Eating behavior improves dramatically. This
reduces caloric intake and ensures that the
patient practices behavior modification by eating small amounts slowly, and
chews each mouthful well. Success of surgical treatment must begin with
realistic goals and progress through the best possible use of well designed and
tested operations. These have been worked out over the last thirty years, and
are now standardized, clearly defined procedures, with well recognized and
documented outcome results.
Prevention of secondary complications of severe obesity is an important goal of
management. Therefore, the option of surgical treatment is a rational one
supported by the time-honored principle that diseases that harm call for
therapeutic intervention that is less harmful than the disease being treated.
The option of surgical treatment should be offered to patients who are severely
obese, well informed, motivated, and acceptable operative risks. The patient
should be able to participate in treatment and long term follow-up. A decision
to elect surgical treatment requires an assessment of the risk and benefit in
each case. Increased abdominal fat or "central obesity" (apple shaped as opposed
to pear shaped) is an important risk factor associated with the major
complications of obesity.
Patients whose BMI exceeds 40 are potential candidates for surgery if they
strongly desire substantial weight loss, because obesity severely impairs the
quality of their lives. They must clearly and realistically understand how their
lives may change after operation.
Weight reduction surgery has been reported to improve several co morbid
conditions such as glucose intolerance and frank diabetes mellitus, sleep apnea
and obesity associated hypoventilation, hypertension, and serum lipid
abnormalities. A recent study showed that Type II diabetics treated medically
had a
mortality rate three times that of a comparable group who underwent gastric
bypass surgery. Also preliminary data indicate improved heart function with
decreased ventricular wall thickness and decreased chamber size with sustained
weight loss. Other benefits observed in some patients after surgical treatment
include improved mobility and stamina. Many patients note a better mood,
self-esteem, interpersonal effectiveness, and an enhanced quality of life. They
have lessened self-consciousness. They are able to explore social and vocational
activities formerly inaccessible to them. Self body image disparagement
decreases. Marital satisfaction increases, but only if a measure of satisfaction
existed
before surgery. If marital discord exists preoperatively, the improved
self-image may lead to divorce postoperatively.
I appreciate your attention to this appeal. If you have any questions or need
any further documentation, please call me.
Sincerely,
Support Your Unions "It's what made America Strong"
I did not have a problem with my Union Insurance. They
are strong and willing to go the extra mile for the healthcare of their members. I
hope any of my Union Brothers who are morbidly obese
and looking for a long term solution to
their weight problems will consider surgery.
HEALTH and WELFARE
Local 501 has comprehensive medical coverage for you and your family. The
union offers some of the best negotiated benefits available with a choice among several
excellent health plans. In addition, your union contract includes options for dental,
vision and mental health.
Las Vegas Office of the Operating Engineers Local
501
301 Deauville
Las Vegas, NV
(702) 382-8452
(SWA) SOUTHWEST
ADMINISTRATORS, INC.
with offices located in
Alhambra, California
Las Vegas, Nevada
San Diego, California
Phoenix, Arizona
This organization through Operation Engineers Local 501 gave me new life, I want
to Thank them personally, both the claims department and the supervisors (she
knows who she is!)
