I got their rationale...

Since I requested the names of the physicians who made the decision on my brachioplasty denial they faxed me a copy of the internal "updates" whi*****luded the physicians rationale.  No mention of lipedema or lymphedema...they just don't mention it nor the fact that it was major part of my appeal and I had a letter from the lyphedema doctor. WTH???? Then he quotes the ASPS WLS patient...grrr...the one I was going to use for this appeal...which actually now gives a better reason for me to bring it in. But quotes where it says, that only in rare cases would excission of excess skin on the buttocks, arms or thighs would relieve functional problems. Then he says...no rare case was presented...WHAT??? He also claims there were no photos documenting skin rashes, ulcers or cellulitis. Again...DID YOU LOOK AT ANYTHING????

Can not understand this blatant disregard of your skin conditions......The photo's tell it all and anyone can see that the surgery is Necessary. Get a lawyer, get a better doctor. Oh Sara I can so understand your frustration and anger.

It sounds to me like YOU are going to have to present all the evidence of medical necessity yourself for this. Obviously these twits are clueless and can't be bothered to actually read the documents you send or look at the photos.

Yeah, I need to ask the benefits admin at which point to I get a face to face with someone!

Definitely! You go and show them EXACTLY what you're dealing with. These people are being ridiculous.

MY GOSH!  So ignorant!  I really do feel for u sweetie.  I honestly think they just plain dont look and just enjoy the ability to deny ppl.  A power trip maybe?  There again too we have so many that are known as the 12 year olds runnin everything now days that not much get done right. I know I will be in deep crap when I have my surgery and need the pannis removed after a while since its already a problem pre op. Goodluck with this next part!      

I think they need to allow you to come in and explain this to the doctors face to face.  You'll have to use very small words so they will understand!  Geez louise. Linda

You know what.... They probably don't have a clue what lipedema and lymphedema is....  They didn't read your information.  Sounds like they need some education about the condition.  Geez...

Dr. Mac letter had a brief tutorial on it..but one who have had to READ it.

What is Lipodema Lipodema is a medical condition that is often confused with lymphedema.  The individual with this condition may appear to be simply obese and/or to have extremely swollen legs and swollen abdomen.  The condition is an uneven distribution of fat cells in the sub-cutaneous regions generally in the legs or abdomen. One major frustration of people with lipodema is that they are accused of being simply "fat," which is absolutely not the case.

Etiology/ Cause:        Unknown Complications: Perhaps one of the most critical complication is the acquisition of secondary lymphedema.  The increased weight can crush the lymphatics causing blockages and hindrances to lymphatic flow.  Another complication is deterioration of the joints and vertebrae from the excessive weight.  Other complications may include varicose veins and/or the deep venous system.  Many lipodema patients also experience a tremendous amount of pain due to the condition and the affects on the body's systems.  Other complications may include "pins and needles" discomfort, decreased vascular flow in the affected limbs and a decreased skin temperature in the affected limbs.

Treatments: There is no known "cure" for lipodema. Because it is not a medical condition caused by over-eating and improper nutrition habits, diets will not a much of an effect.  Neither can the condition be treated with medicines or diuretics.