Question:
I was denied for a TT by Cigna can anyone help?

Hi all, Well I received my denial todsay. The reason is the followin (typed word for word from letter): Medical necessity does not yet appear to be establiashed. Required for documentation and approval of the requested service, panniculectomy, the following are needed: A> Panniculus causing persistent intertriginous dermatitus or panniculitis that is refractory to at least a six months of medical management(good hygiene pratcices with any of the following: topical and/or systemic corticosteroids, antifungals, topical and/or systemic antibiotics) Clinical notes on above treatments MUST be submitted. B. Pre-operative photographs Must be submitted, demonstrating the presence of panniculus which extends below the symphasis pubis, No photos were received. No 6-months of conservative therapy for the above indications. We have determiined that the requested services do not meet the definitions of medical necessity found in your benefit plan. Ok so here are my questions~ Anyone else go through this? Where the heck is my symphasis pubis? And what do I do now? I am so bummed I was scheduled for October 6th, I also was supposed to have a revision for my breast reduction scars which are hypertrophic and keloid. I also have my second hernia. Any advice? Thanks Stephanie    — Stephanie B. (posted on September 9, 2003)

September 9, 2003
I don't have Cigna insurance, but my insurance company required documentation of medical necessity before approving a pannus removal. If your doctor can document treatment for rashes or infections under the hanging skin and if you provide pictures showing that the excess skin hangs over your pubic area, your pannus removal may be considered medically necessary. I would appeal the denial. In the meantime, seek treatment for rashes or infection under the pannus, have pictures taken, then have the request for approval resubmitted. Good Luck!!
   — Char S.

September 12, 2003
Hi Stephanie - I just won my battle with Cigna for a TT. I had to appeal. My husband says they'll deny everyone the first time and lose 1/2 the people because they won't bother to go forward. I wrote a great letter and also had letters from my PCP, nutritionist, plastic surgeon, gastric-bypass surgeon, psychiatrist, and Curves. I submitted polaroids that my husband took that were just disgusting. And I submitted articles from the American Plastic Surgeons Society, details from my benefit plan, the AMA definition of cosmetic v. reconstructive. I'd be happy to share my letter and websites I looked at if you want to email me. I had it done 3 weeks ago, it was/is rough, but will be fantastic! Be persistent!! Good Luck!
   — jen41766