RN with an insurance company!

Hey, all you nurses having trouble getting approved - I would be happy to help in any way. I work for a self-funded plan doing case management. Soooo... that means I know our plan inside and out. The bottom line is that I got our plan to approve my husband's WLS with a BMI of less than 40 and got the criteria changed. Then, last spring, I got my abdominoplasty approved, despite an exclusion for "panniculectomies and similiar surgeries after weight loss surgery". I really believe there is a way to get just about every plan to pay for WLS surgery. It just has to be found. Appeal, appeal, appeal! You can go to my profile and send me an e-mail. I'll do whatever I can. This surgery has made such a positive impact on my life that I want to help as many people as possible have the same opportunity. Sue

That is so sweet of you, Sue! I know that some people have fought and fought their insurance companies and any help they can find would be wonderful. Jeanie in MO DS 02/11/05 "Duodenal Switch: My New Beginning"

That is so giving. If I have trouble I will let you know. My BMI is 39.4 so I might be getting in touch with you. This is such a great thing that you are willing to do. Thanks, Nancy

How did you find out what physician to go to for your panni? Did you have to "shop" around? When did you go? What weight should I be at? I have 37 pounds to go to get to my goal and am 10 months out (down 128 can you believe it?). My internal medicine doc says I probably have about 15 pounds of skin. I carried most of my weight there, and boy is what is left over -UGLY. Plus, major back and hip aches because my whole weight is pitched forward since there is not much left to counter balance the hanging ab. I have Medical Mutual. They paid for the RNY, but is there anywhere I can look to see if they pay for the ab surgery? Thanks for any help and info! Have a great day!