Question:
HELP!! with denial from BC/BS for arms
Denied today 10-10-03 for arm lift they said "COSMETIC" I advise I wanted the information for appeal letters to be sent. I need help as to the content of the letter I need to send. Any help will GREATLY appreciated. They covered my TT, I have lost 130 #'s please send any info or ideas.Lisa — Lisa N. (posted on October 10, 2003)
October 10, 2003
Lisa, Save the paper and your stress. From what I've seen BCBS will NEVER
pay for arms to be done as there is no functional problem associated with
bat wings. It is strictly a visual or cosmetic thing. It would be more
worth your time to start saving up instead.
<p>Be glad they covered your TT as I just got my denial for an
abdoninoplasty but they did leave the door open and say that when I'm at
the weight I want to maintain that I should submit an orthopedic evaluation
and recommendation and new pictures and they would reconsider. It almost
sounds like they want to approve it but need to find a way to do it.
— zoedogcbr
October 10, 2003
Hi Lisa! I am a pre-op, but from what I have read on previous postings, if
you are having yeast infections, cysts, boils, razor burn, etc., those can
prove to be medically necessary. If you have any of these things, take
before pictures, go to your doctor and ask for a prescription for it and
make sure the doctor documents for exactly what it is for. Use the meds,
see if it help, if it does, take another "after" picture. Stop
using the meds, go to your doctor and keep repeating the pattern and have
your doctor keep documenting it. Also search the library, because I think
that there are some examples of appeal letters for RECONSTRUCTIVE surgery
for "batwings". Hope that this helps, good luck!
— SherryWeber
October 10, 2003
I have federal BC/BS. I had a breast lift done with implants and they
payed for the breast lift. How that got pass them I will never know, but
am not going to look a gift horse in the mouth. They denied my
abdominoplasty even though I had a hernia. I appealed twice and was
denied. They paid for the hernia repair, so my hospital bill and
everything was paid and I cut a deal with my wonderful plastic surgeon.
Everything else, I'm not even going to try for.
— Lisa N M.
October 11, 2003
I'm in Michigan and I've heard that if you have a lot of skin to be removed
that U of M will do it for free, just to get the skin for burn victims. I
would imagine any burn center might do the same. Good luck.
— kkubinski99
October 11, 2003
Hi Lisa.....I've just gone through this with BC/BS of Michigan....in fact,
I'm still in the middle of it. I had breast implants and brachioplasty
(arm-lift) at the same time. BC/BS denied it as cosmetic. I appealed and
they denied. I appealed again and they denied again. I went ahead and
paid for it out of pocket and had my surgery done and afterwards a friend
of mine said that there are insurance companies out there that will pay for
it and as long as you don't have an exclusion in your policy for that
particular procedure (which I don't), then FIGHT! So, I'm fighting. I
appealed again (AFTER the surgery) and they said they couldn't appeal it
because they'd never received a claim for it. Well of course not! Why
would the hospital make a claim if it was denied in the first place? My
denial letter stated that I could contact the auto workers national appeal
people if I still wanted to appeal. I contacted the auto people and they
are quite willing to try and get it approved, BUT.....before they can get
involved, I have to have a claim submitted to BC/BS....BC/BS has to deny
it.....I have to appeal their denial on the actual claim.....AND THEN the
auto national appeals people will take it from there and see if they can
get any of it approved. After talking to the national appeals unit, I
called my surgeon's billing office and they put me in contact with the head
of the billing department. I explained the situation to her and she said
that the U of M has a contract with BC/BS and they have an agreement with
them that if they collect money from a patient up-front, then they can not
bill BC/BS.....so they sent me all my invoices and surgical reports and I
filed the claim with BC/BS this week. Now I have to wait for them to deny
it, appeal that denial, and then get the auto national appeals people
involved. Do I expect any reimbursement from BC/BS on the $8,477 I paid?
Who knows....it doesn't take too long to type up a letter and 37 cents for
a few stamps, so it's worth playing the games if I have to! <p>
<p>BTW, I had mine done at the UofM in Ann Arbor, and in regard to
what the other poster said about burn units doing it for free if you donate
the skin isn't necessarily so. I've heard that a few people have contacted
them and they will only consider it if there's no stretch marks, blemishes
of any kind, scars, etc. Good luck to you!
— Lynette B.
October 12, 2003
I was told by my surgeon and primary doctor that they need to start
recording on my visits problems I'm having with my extra flesh. Example:
rashes, rubbing, etc. So when I'm ready to have the surgery it is already
documented on my medical file.
— Linda R.
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