Question:
Can somebody tell me what physiological function means

Am trying to get a tummy tuck but was denied Before I appeal I was looking in my insurance book and it says Does not cover operations for cosmetic purposes done to improve the appearance of any portion of the body, and from which no improvement in physiological funtion can be expected due to my panni I get rashes and infection and surgery would help correct that problem would that be considered a physiological funtion or not Thanks in advance for any help anyone can provide    — Domingo R. (posted on August 13, 2003)

August 13, 2003
Physiologic means functional - as in they think they don't cover a tummy tuck if there is no functional improvement to be had. Example: Someone who has the skin hanging over their eyes trimmed back has a functional improvement - they can see better without the skin obscuring their vision. A nonfunctional improvement would be if the eyelid areas were saggy but not blocking the person's vision. In your case, I think elimination of rashes and infections would be a functional improvement, but you'd probably have to have documented rashes/infections in your doctor's notes to use this as ammunition.
   — bethybb

August 13, 2003
Difficulty walking would get you approved. MLR
   — Kriola

August 13, 2003
Also any back pain associated with heavy skin folds (some of us larger WLS pt will have tons of skin). Along with the documented rashes etc. Jamie
   — Jamie M.

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