denial

well I got turned down for the second time for pannilicutomy....im  kinda pissed.their gonna keep giving me the run around and skirting the issue.Im just gonna self pay and get this over with...my surgeon quote is about 3000.00 for panni surgery is that resonable or should I look else where.I live in colorado and have united medical alliance insurance.its always gonna come down to "its cosmetic"no matter if your pannius hangs to your knee's"its B.S no matter how many rashes or infections or meds you were precribed it will always be considered "cosmetic"what a waste of time and anxiety and got my hopes up,im soo disappointed and upset.so now the next step is self pay,which I dont have laying around or getting a bank loan with interest or using a surgery loan option with interest or borrow from a family member with no interest.they all seem overwhelming..I dont know im really confused but determined to get this done,Ive come this far and cant give up now to really reach my ultimate goal,Ive lost the weight and now I need to go to the next phase and start the body contouring phase to complete this journey.I'll pray on it and think and think I'll figure it out just thought someone has any good experiences or suggestions or ideas on which way I should go...I need help!!!!Thanks CAT

I'd like to know what people pay for that and for the full tummy tuck as well.  I know it varies by region and even by individual cities within states.  However, it would be nice to have a range.

I agree...my surgery is in just over 2 weeks, but I'm already thinking about starting to save for the plastic surgery that I'm sure I'll end up needing.

I'm still going to try to do anything and everything I can to reduce the amount of skin leftover, but I've been 100+ lbs overweight for at least 20 yrs, so I'm pretty sure my skin won't bounce back very well!

I've heard that some plastic surgeons will do tummy tucks and bill them as hernia repairs, but that's only hearsay so I could be completely wrong on what I've heard!

Jen

With my experience with other surgeries I had and my RNY, it's all how the surgeon writes what is needed and the reason for the surgery.   It can be frustrating.  I have a few friends who have used the plastic surgeon I am going to use in 2.5 yrs for my body lift and he writes the way the insyrance wants it to be and has had no problem with the insurance approving it.

Sorry, but I would not let your insurance company get away with this,  If you actually have medical necessity for the procedure, I would demand that they grant you an appeal by an independent panel, which you are entitled to under ERISA statutes.

Bone up a little bit on insurance statues and go after them.  Make some serious threats to not only report them to various regulatory agencies, but also threaten private litigation.

I do this for a living, seriously, and I will tell you that while I don't win all my appeals, I do win most of them.  The trick is to not back down, and to sound like you know what your rights are.

In many of my appeals, I simply BS and just bluff like crazy, and I'm telling you, you'd be surprised how many previous insurance denials I get paid on appeal.

Thanks deb,I did appeal again and this should be infront of a panel  and the guy who turned me down will not have any say....so Im crossing my fingers.if not I'll go again,I told them I turned in everything what else could I turn in,so im appealing with everything I submitted this last time...my next step would be to go in there and pull my pants down and show them face to pannus....