plastics approval with medical mutual?

Anyone in this area been approved for a panni or abdominalplasty using medical mutual ohio or carefirst blue cross,blue shield? I do have rashes and reacurrent yeast infections do to the extra skin. Any help, would be greatly appreciated

Hello, I have not tried to seek coverage for plastic surgery yet but I am anticipating a royal PIA with Medical Mutual (Ohio's Get Well Card - as long as you don't get sick). I am in the middle of a appeal and denial process which is simply ridiculous. The long and short of it is that I had undergone a Jejunal-Ileal Bypass procedure on June 30, 2004. This procedure as every educated surgery candidate knows is not accepted anymore and is part of the hybrid procedure know now as the Roux-N-Y Gastric Bypass. I had a series of comorbidities including diabetes, sleep apnea, atrial fibrillation, CHF, slow healing wounds, shortness of breath and the like. If I had undergone a standard Roux-N-Y, I am told I would not be writing this today because of my size (I was 528 lbs at my highest) and health status. Anyways, my surgeon suggested a two phase approach. The J/I Bypass would allow me to lose a significant amount of weight and then when the perioperative risk was lowered it would be converted to a long limb Roux-N-Y. The long and short of it is that as of 7/1/2004, Medical Mutual has excluded weight loss surgery and has subsequently denied my request for the conversion. I have appealed was denied and now am pursuing a complaint with the Ohio Department of Insurance. The side effects of a J/I Bypass are so severe as to be fatal (liver failure, kidney failure, malnutrition). Obviously, my request is based on medical necessity but it was denied based on contract exclusion. Sorry to be long winded but I steam everytime I see Medical Mutual. Good luck with any requests to them. Mark P.S. To date I weight 248 lbs.....( a net loss of 280 lbs. That plastic surgery will be required and hard fought for.)

I too was denied for my surgery and finally won after my appeal with Med. Mutual. Good luck. I am sure that i will have to fight them again. I am ready for it.