The following is the letter that I sent to my insurance company to appeal the denial of my weight loss surgery. Along with the letter I also included a diet history and a print out from the National Institute of Health with highlighted statistics that support the health risks of continued obesity.

August 4, 1999

Dear ...,

I believe that I am now writing the most important letter that I have ever written. As you can see by the enclosed copy of the letter from (my insurance company), I have been denied coverage for a gastric bypass due to an exclusion in the company's insurance policy. I am enclosing information that will hopefully make you see that denying this surgery to me may prove only to cost the company more money in the long run.

I am only one of over 1.5 million Americans who suffer from Morbid Obesity. Actually, I fit into the category of Super Obesity or Malignant Obesity. I am 5'0" and as of this morning weighed 268 pounds. I am carrying 148 extra pounds over my target weight. I have tried every diet out there and despite my considerable efforts, I haven't had any long-term success with weight loss. Instead, I have only gained weight over time and in turn have developed physical symptoms that are becoming harder and harder to live with. I live in pain every day from arthritis (fibromyalgia) and considerable back pain from carrying all of my weight around. I am unable to walk, except for short distances and this greatly effects my life and limits what I am able to do physically. My knees and feet hurt and I have difficulty going up and down the stairs in my house. I have suffered from asthma for a number of years. My pulmonary doctor feels that my asthma could only be helped by weight loss. I also suffer from Gastro Esophageal Reflux. This leaves me with uncomfortable heartburn that I deal with on an almost daily basis. I treat it with over the counter medicines when it becomes unbearable. I have been told that this will most likely go away with weight loss. These are just some of the physical symptoms that I deal with during the course of my day.

According to the National Institute of Health, I have a mortality rate that is 1200% greater than others of the same age who are of normal weight. It is not unlikely that I will develop serious complications in the future. I have an increased risk of heart disease, as well as ovarian, cervical, uterine, and breast cancer. These complications would cost the company far more than the cost of gastric bypass surgery. I am at risk to develop diabetes because of my weight. Type II diabetes is on both sides of my family tree. Both of my grandmothers take medicine to treat their diabetes. My mother suffers from dangerously high blood pressure and must take medicine to keep it under control. It makes sense economically for the company to provide the surgery before I suffer from any additional life threatening diseases.

As stated in my diet history, I have tried everything, including an outpatient treatment center for eating disorders at Lutheran General Parkside in Park Ridge, Illinois in 1992. Again in 1998, I spent one-week inpatient and three weeks outpatient in an eating disorders hospital program at the Rader Institute in the Los Angeles area. The insurance company paid for both despite undesirable success rates. The Rader Institute program cost somewhere in the neighborhood of $10,000. The gastric bypass, that I am seeking, has a success rate of 80-95%. No other treatment for obesity offers this rate of success. If I had mild obesity, I would not consider surgery. As someone who suffers from Malignant Obesity, I feel that this is the only option that will give me a normal and healthy life. I have done my research regarding this surgery and feel confident in my decision and choice of doctor.

In addition to the physical problems, I feel you should also be aware of some of the other complications of weight that I deal with. I have problems that normal weight people take for granted in their lives. I have a hard time tying my own shoes, fitting into seats at the movies, in airplane seats, and booths at many restaurants. Because I am so large, sitting in chairs that have arms is hard for me. I have a difficult time finding clothes that fit. Seat belts don't fit me in many cars. I don't like hearing young children say, "Mommy, look at how fat that lady is." I am unable to hike, bike, rollerblade or be physically active with my children. I am also subject to the ridicule that society allows against fat people. Making fun of the obese is the only socially acceptable form of bigotry that still exists in this country. I do not tell you this to get your sympathy, I only tell you so that you have the true scope of how this disease effects me on a daily basis. There was a time in my life that I would have liked to lose weight because of my vanity. Now I feel that it is a necessity that I lose weight so that I will be around for my family in the future.

I understand the company's need to prevent unnecessary procedures and treatments. However, the company would best serve it's employees by changing the policy to read that it "doesn't cover the surgical treatment of obesity, except when medically necessary." This would mean that surgery should be available to individuals who are at least 100 pounds overweight of have a Body Mass Index (BMI) of 40 or greater. I have a BMI of 54.1. This change would effect a very small percentage of people who are under the insurance plan. For these people, the surgery would be less costly than treating the co-morbidities associated with being Morbidly Obese.

I have enclosed information that supports what I have told you in this letter. I have included a copy of the denial letter from (insurance company), a diet history, a letter from the office of one of the two doctors that I am considering to perform the surgery, a letter of recommendation of one of my doctors in Las Vegas, an article from the National Institute of Health on the implications of obesity, and information on the Fobi Pouch obesity surgery. Please say yes and allow me to have this life saving surgery.

Sincerely,

Susie Goldstein