Question:
Any suggestions re appealing denial of pannilectumy by Coventry Health Care?

I have lost over 180 pounds since 6/10/03. My insurance carrier (Coventry Health Care) denied my request for a lower body lift because they said it was COSMETIC. Anybody have any experience with Coventry on this issue? Many thanks!    — Vickie W. (posted on July 9, 2003)

July 9, 2003
Vickie, I don't have the same insurance, but I'm in the same boat as yourself, I too am in need for a lower body lift or TT as the doctor puts it, and was denied, as they said it was COSMETIC,. I just started the appeal process today, girl FIGHT it ! That's all I can say, get with your doctor's have them write you letters backing up your actual appeal. Stand tall we shall triump over this ! Hang Tough, if you need anything email me. Best of luck Post op 14 months post op down 130 pounds
   — tannedtigress

July 9, 2003
I am ready to send my appeals packet in -- if you'd like a copy of my letter and the links to sites I found, email me at [email protected] I'd be happy to share!
   — jen41766

July 9, 2003
I'm in the same boat with everyone else regarding body lift. Frankly, I think TT, breast lift and arms should be approved when we get our WLS approved. It's so depressing to be fat, but then we lose all the weight and are still depressed because we look like a melting Pillsbury dough girl. The plastic surgeon's office that I went to last week said one woman continued sending in letters and each time we send in letters to the insurance company they have to go through the approval process which costs them money -- she sent in so many that they finally approved her. I'm too impatient to continue writing all the letters to the insurance company -- I want it NOW. Good luck to all of you that continue to fight -- I'm on your side for sure, I just wish I had the patience for it.
   — Betty Todd

July 10, 2003
I have BC/BS of Florida Health Options (HMO) and I was approved for abdominoplasty AFTER an appeal. They too said is was cosmetic surgery but I insisted that it wasn't. They key to having your surgery approved is to show it's medically necessary. I think the one that that overturned my denial was I had my Primary Care Physican to conference call the review board during my appeal review. Good Luck and don't give up! Fight until the you get APPROVED!
   — Jeanette D.

July 10, 2003
Go to my profile and read what I had to say about Coventry. I HAD them, I now have Aetna, Aetna approved my WLS in a matter of HOURS after my surgeons office faxed over all of my paperwork to them. I will be looking into having a tt and breast lift soon. I still have Aetna, but it is through a differet employer and instead of a POS, I have an HMO. I did appeal with Coventry but they kept denying me, I got tired of fooling with them and dropped them like a bad habit. Good luck to you, but frankly you would be better off changing providers when the open enrollment period comes up if your insurance is either through your or your husbands job.
   — gloriafb

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