Question:
Help! My arms are flapping and I've been denied
I've now lost 166lbs. Aetna has paid for me to have a tummy tuck, but they claim the arms and breast lift are cosmetic in nature. What do I need to prove that this is necessary and not cosmetic? Would a letter from me be enough, or does it need to be from my doctor? Any suggestions? Lucy — Lucy B. (posted on October 30, 2001)
October 29, 2001
I would take pictures of all in question, have your PCP write a letter
regarding the issue, and you write a letter as to why you believe it should
not be considered cosmetic and send that in. GOOD LUCK!
— [Anonymous]
October 30, 2001
Hi. I'm not that far in my journey yet, but my arms are already flapping
at 110 lbs loss...so I think the brachioplasty is in my future as well. I
have heard of people having it covered because they nicked the hanging skin
when they shaved under their arms. I have also heard of people having
trouble with their shoulders because of the hanging skin. If your PCP
documents some of this....that may help you out. Good Luck and keep us
updated:)
— Nicole P.
October 30, 2001
Hi Lucy...
Sharp Health Care won't even pay for the tummy tuck. I will be self-pay
for a TT and brachioplasty on Nov. 1. Had to take out a home equity loan.
If you find any way for the insurance to pay for implants and a thigh lift,
please let me know!
— Anne G.
October 30, 2001
Your insurer won't pay for brachioplasty unless you can prove
extremen functional impairment....i.e. the hanging skin is so
streme that it prevents you from wearing clothing and from
activities of daily life. I only know of one person who got approved.
Her arms were truly deformed after she lost 300lbs. She couldn't wear
clothes and the excess skin and fat was so heavy that it was causing
neck and back spasms. She also had trouble moving her arms in certain
positions. I've known hundreds of folks in group and I never saw another
with such an extreme and debilitating problem. That's what you would have
to document....with pictures....to get approval. For the vast majority of
us
(myself included) batwing deformity is a cosmetic issue.
— [Anonymous]
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