Question:
My plastic surgeon submitted a letter of medical necessity which was denied by my

insurance co. He now refuses to file a letter of appeal. How do i go about doing this myself.I phoned my insurance co. I was told that it is always best to have the appeal from a dr. Any Ideas anyone    — STAR W. (posted on July 7, 2002)

July 7, 2002
Sit down and make a list of all the problems your having due to NOT having the plastic surgery. Put this in a nicely worded letter that begins, "I'm appealing the denial of the plastic surgery request for" and continue from there. Call the insurance company and ask who's attention this letter should go to. The insurance company typically has 30 days to respond to the letter.
   — Patty H.

July 7, 2002
I had my tummy tuck and armlift in November. My secondary insurance approved right away, but the primary provider denied. I contacted my primary provider and got the information about their appeals process, which in my case involved putting together a packet of information which would support my need for "reconstructive" surgery. They also told me that I might be prepared to personally appear before the committee to "plead my case", but that was never necessary. They already had the original letter of medical necessity and photographs that my plastic surgeon had submitted, but when I put my packet together I included another copy of his original letter and did not ask him to write an additional letter. Also in the packet, I included letters of medical support from my PCP and the bariatric surgeon who performed my RNY. Then I included a lengthy personal letter in which I outlined all the physical and psychological/emotional reasons that I felt this "reconstructive" surgery was necessary.....always stress the term "reconstructive", and never let anyone infer that this surgery is cosmetic in nature. Lastly, I included a copy of the 1996 Position Paper of the American Society of Plastic Surgeons, entitled "Treatment of Skin Redundancy Followinig Massive Weight Loss". I found this paper at www.plasticsurgery.org/profinfo/pospap/skin.htm. My surgery was approved within a week of the appeal. I hope that you have the same good luck!
   — Diana T.