Question:
Is Morbid Obesity a disease? If so, I need an ex: of an appeal letter for a mastopexy
I had my WLS in march of last year. I have lost 110lbs and had a tt last november that I paid for myself because the insurance deemed it wasn't medically necessary. I didn't appeal because I basically agreed with them. I didn't have rashes or anything, I just didn't like how much extra skin I had. But my breasts are a different story...I do get a rash, and they are like hanging deflated balloons now because of the weight loss. My insurance policy states that NOT covered are "cosmetic procedures intended to improve the appearance, except for reconstructive surgery to: 1. treat an accidental injury 2. Restore normal bodily functions or to correct a deformity caused by DISEASE, trauma or previous covered therapeutic treatment 3. treat a woman after a mastectomy" Isn't Morbid Obesity a disease? I thought so, so if it is, don't I have a good chance of winning an appeal? I've searched, hunted, combed and read all the headings of the questions in the library under "appeal", and none of them say anything specific in the title about mastopexy. I would have to open up, and read, literally hundreds of letters, and most of them end up being about WLS itself, or about abdominoplasty. So my question to you is: Is there ANYONE PLEASE who has an example of an appeal letter for a mastopexy. I have rashes under my breasts, and have pictures and documentation of the rashes that were not sent in by the PS. I welcome any advice you can give me! Thank you...thank you....thank you in advance!!! — blank first name B. (posted on May 27, 2003)
May 27, 2003
It is a disease. You can find references here, including info from the
National Institutes of Health and National Academy of Sciences' Institute
of Medicine.
http://www.obesity.org/treatment/obesity.shtml
— TMF
May 27, 2003
Hi- just a small point...You might want to look at the words "caused
by previous(ly) covered therapeutic treatment" carefully. Was your WLS
covered? Was it a therapeutic treatment? Did it cause/add to your current
problem? Good luck and CONGRATULATIONS on your success!!!
— Rebecca T.
May 27, 2003
The criteria for BCBS of Michigan is if the doctor can remove 500 grams of
tissue from each breast, then the surgery is considered reconstructive and
medically necessary. They covered mine. I went from a D cup to a B cup and
couldn't be happier. Instead of tube socks with nipples, I have the boobs
I had when was 15! Good Luck!
— merri B.
May 29, 2003
I'm appealing for my tummy right now with UHC and found the documentation
to support that point - that obesity is a disease. National institue of
Health, World health organization, Food and Drug Administration, and the
IRS all have positions on this FACT. I'm at work right now and don't have
the sites handy, but they were pretty easy to find once I knew what
agencies support this.
— missesrita
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