Question:
Why is this surgery considered cosmetic?

I just received my denial letter from the insurance company and they state that "cosmetic, plastic and reconstructive" surgeries are covered for different reasons, but based on information received, it is not medically necessary for me to have the surgery. Can someone please explain this to me? Since when is trying to improve your health "cosmetic"? Jean Taylor    — jeannieree (posted on April 13, 2000)

April 12, 2000
Unfortuanetly the ins co views it as cosmetic because they think you want to lose the weight for apperance reasons. Also by denying you then they don't have to pay for it. The ignorant society we live in thinks obesity is a choice and if we cared about our bodies and health so much we would just lose the weight. Easier said than done. Maybe your doctor did not do his job well enough in proving a case to the ins co for a medical necessity. I would definately gather more info, consult other doctor's and file an appeal.
   — Julie H.

April 12, 2000
Absolutely, what Julie said. Good job, Julie!
   — Jaye C.

April 13, 2000
I was also turned down so I know how you feel. You can find a sample appeal letter at www.clos.net/sample_appeal_ltr.htm It will help educate the insurance co. Best of luck and don't give up.
   — Donna A.

April 13, 2000
Check out the obesity law site for more ideas. One of the things they go over there is how some companies automatically deny the surgery the first time because even if the law forces them to pay, they don't have to pay damages, just the cost of the surgery. Odds are most people give up after the first try. Something else to consider too. Don't have your PCP write up your request - have an experienced surgeon do it. My doctor has NO experience with this surgery at all, and the difference between his view of it and my surgeon's is unreal (my dr. lists 2 co-morbidities, my surgeon lists 9, for example)
   — Kasey K.

April 13, 2000
LOOK THEY ONLY ARE TRYING TO GIVE YOU A HARD TIME DON'T GIVE UP PLEASE LET US KNOW THE INSURANCE COMPANY YOU HAVE . AND IF THEY DON'T COVER IT GET ANOTHER INSURANCE THE BEST INSURANCE TO HAVE IS THE BLUE CROSS BLUE SHEILD. IF YOU HAVE TO GET A HMO GET HMO ILLINOIS THAT IS A BLUE CROSS COMPANY. THEN CALL WEIGHT FOR LIFE AND TALK TO GINNY AND SHE WILL HELP YOU THE NUMBER IS 1-800-876-2121 TELL HER TAQUITTEE SENT YOU. AND YOU WANT TO LEARN ABOUT ME LOOK UP MY PROFILE PAGEON THIS SITE AND MY WEB SITE IS HTTP://HOMETOWN.AOL.COM/TAQUITTEE/MYHOMEPAGE/INDEX.HTML AND YOU WILL LEARN MORE ABOUT ME . AND MY FIGHT WITH EVERYTHING.
   — Taquittee

April 13, 2000
All ins. companies have different exclusions but, this procedure isn't for cosmetic reasons. Get into the files here or the NIH and other weight loss sites and they will help your insurance to see that it is medically necessary not cosmetic! Get the facts before you try to tackle them on this. Look at your co-morbidities and talk to your doctor about them. Hope this helps.
   — char T.

April 13, 2000
Gee, another insurance company totally ignorant about obesity and WLS - surprise, surprise. DON"T let them get away with this nonsense. WLS is not cosmetic. Research and keep at it. Eventually they will cave! Good luck:)
   — Paula G.

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