Question:
I was denied for my Tummy Tuck, please help.

It's time for my tummy tuck and my insurance says it's cosmetic surgery. My Dr. says no way. I need some help and ideas how to approach an appeal. Thanks    — Tammy Z. (posted on November 18, 2001)

November 18, 2001
Have you had the doctor write a letter of medical necessity saying that all your back pain and skin infections are directly caused by the weight you are carrying in front. Go to an orthopedic surgeon about your back trouble and have him write the letter saying that as long as you are unable to do anything with your stomach muscles they will not uphold your back muscles and you may need back surgery as well. These insurance companies want to say that each individual part of our bodies are seperate and need to be treated seperately. One cannot work without the other. When will they realize that.
   — K T.

November 26, 2001
I am one week post-op from my abdominoplasty and armlift surgery. My secondary insurance provider approved the surgery as a "reconstructive" procedure, but my primary insurance denied coverage. I followed the appeals procedure for my primary provider and was immediately approved. My plastic surgeon stated that it was almost "routine" for insurance providers to deny coverage initially, but that most were providing coverage following a little extra effort on the part of the patient to appeal the decision. The packet that I submitted to the appeals committee consisted of my own letter which outlined the initial benefits of the WLS to me, as well as my feelings about why the reconstructive surgery was necessary and how it would enhance my life.....this is your opportunity to be as "emotional" as you like....let them know how important this is to you, physically and psychologically. Then I attached supporting letters from the plastic surgeon, my PCP, and the surgeon who performed my WLS. Each of these physicians stressed my prior co-morbidities, the benefits of the WLS, and the fact that they professionally considered this final surgery to be reconstructive in nature, as opposed to "cosmetic". Finally, I enclosed a copy of the 1996 Skin Redundancy Position Paper from the American Society of Plastic Surgeons. The paper is entitled, "Treatment of Skin Redundancy Following Massive Weight Loss". A copy can be obtained from http://www.plasticsurgery.org/profinfo/pospap/skin.htm. This is what worked for me...good luck!
   — Diana T.