Kriola
TT letters
Jul 22, 2007
From OH:
To Whom it May Concern: I am not requesting these surgeries for cosmetic reasons. These surgeries are reconstructive following massive weight loss per the American Society of Plastic Surgeons and the American Medical Association. This letter is in response to my denial for Abdominoplasty and Medial Thigh Lifts with Dr. John T. Louis. Your insurance company gave me approval on my Open Gastric Bypass on To whom it may concern, In May of 2003 I underwent surgery for gastric bypass. As of today I have lost a total of 199 lbs. As a result of this loss I have excess skin which causes recurring rashes and infections in my abdominal area, groin and knee area. These rashes will at times bleed and are always a source of pain and itchiness. I have also had rashes in my navel. I cannot stand for too long because the pulling skin will cause back pain. This has just begun and needs to be remedied prior to causing permanent damage. In addition, in the summer months I have painful rashes in the thighs and groin because of rubbing and the heat. Not to mention the odor that occurs within the folds of the excess skin. The excess skin around the knees has caused difficulty in walking and pain. The pain in the knee even occurs in bed if I try to lie on my side to sleep. My PCP has prescribed a couple of different medications for treatment (Clobetasol Propionate Cream USP. 0.05% and Clotrimazole 1%) and I have used these to no avail since September 2004. Photos of excess skin and the rashes were provided some of which were taken at home to document rashes the others provided by Dr. XXXXX. I have been denied services of an abdominalplasty and medial thigh lift. The reason provided to me and my Physicians was that I was requesting coverage mainly for cosmetic purposes and that I had not documented weight loss and or demonstrated stable weight. My weight for the last 4 months has only fluctuated by 5 lbs. Regards, Enclosures:
For years I have suffered with back pain due to my obesity. When I would talk with my doctors, they would all tell me to lose weight, then I would feel better. I lived with the pain and limitations because all my attempts to lose weight throughout the years had failed. I finally found a solution to my obesity and lost 140 pounds. The weight loss though gave me a massive amount of redundant skin. This redundant skin in my upper & lower abdomen, puts a tremendous amount of stress on my lower back. I also suffer from panniculitus, that beagn after my initial 100 pound weight loss in February 2003.
My primary care physician, Dr Susan Whitely,as well as her Physicians Assistant, Sally Hartzell, have included a letter stating all of the medical steps I have taken to prevent the recurring panniculitus. I also must bathe two times a day, using a hair dryer to thoroughly dry the fold of skin under my enormous pannus.I then must place two sanitary napkins under the area to keep it dry, if I do not I sweat causing a rash and a foul smell.
My primary care physician, Dr. Susan Whitely, suggested that losing the excess weight I was carrying would relieve the stress excess weight put on my back.. When losing the weight didn’t decrease the pain, she suggested I try physical therapy to strengthen the muscles. I did go through physical therapy and continue to do the exercises I was taught on a daily basis. I also must wear a full size girdle everyday to provide some support to the pannus and my lower back. If I do not wear a girdle I end up in debilatating pain by the afternoon. I have also included a letter from my gastric bypass surgeon and hernia surgeon, Dr Terry Simpson, this letter shows that I underwent repair of an incisional hernia on
I have included a letter from Dr. Susan Whitely as documentation and verification that my pain is real, and that she has worked with me to help me with my pain. She states that the requested surgery is medically necessary. For the past 13 months I have made a strong effort to keep an exercise routine, however, my routine is greatly hindered by the pain of a large pannus and always causes me to end my routine early. I have to keep exercising if I want to keep my weight down and if I want to keep my health. I can’t keep my weight off without exercise.With the recurring hernias I am also unable to perform all of the abdominal muscle strengthining exercises I was trying to include in my daily exercise routine. Sometimes when I am doing my brisk walking exercise after 25 minutes or so,I have tears running down my face because of the pain in my lower back. I take pain medicine, Diclofenac two times a day so I can function during the day.
The surgery I am requesting is definitely of a Reconstructive nature and NOT cosmetic. I am aware that the surgery leaves noticeable, permanent scars, according to the AMA’s description. I am not requesting this for cosmetic reasons.
Sincerely,
Here is another:
I now suffer from chronic consistent rashes under my Pannus area that are extremely painful and unhygienic. The area becomes extremely raw almost in a blistered scalded state and oozes a yellowish discharge that emits a foul odor. This discharge not only smells horrible it leaves a stain on my clothing as well. I have been self-medicating the area with Lotrimin, Tinactin, Gold Bond Powders, antibacterial soaps as well as many other home and over the counter remedies. Nothing that I have done has been able to alleviate the problem. I have been to my primary care physician to get help with the situation and was given Ketoconazole 2% Cream 60 Grams, which helps but does not get rid of these infections. I wear a soft sock under the area to help with the rubbing and friction but this is not very effective either. These eruptions normally will last anywhere from 3-7 days and return normally in about a week to two weeks (if I am lucky). I suffer with these infections under the Pannus area, the juncture of my thighs, my belly button, under arm pits, back of the knees and under my breast. I’ve tried blow drying the areas and using anti-perspirants to no avail. These infections have severely limited my desire to have personal contact with my husband. I just never feel clean and am very embarrassed from the odor. Not to mention the pain involved. Imagine what it must feel like to have your skin scalded with hot water on a consistent basis. It burns and is extremely sore. In the beginning it is very itchy also. I feel this almost all the time. It’s like being tortured by your own body. Nothing that will kill you but it can certainly work on your mind and your self esteem. As a person who is already diagnosed with clinical depression this only adds to that problem.
Before my RNY, I was limited to walking no more than just a few feet and was only able to do this with the assistance of a cane. I suffer with Degenerative Osteoarthritis with major damage to my knee joints that will need to be replaced in the near future. The huge mass of hanging skin from the Pannus now makes me over compensate when I walk and puts extra stress on my lower back and legs. Exercising and walking can be an uncomfortable problem as the pull and tug of extra skin flapping with each movement. I do wear support panty hose as well as stomach and thigh girdles to help support the extra skin
I hope you will look into my case with a new sense of urgency as the problems that I have are a direct result of my disease of Obesity. I feel that if I had been diagnosed with cancer and my breast had to be taken you would have no problems approving reconstructive surgery. These issues that I suffer from are no less debilitating than if I had Cancer. This 10-15 lb mass of hanging skin is no less of an issue than if I had a cyst that was growing from my abdomen. I do not want to be a failure in my fight to live a relatively normal life. After reviewing the following information that you have posted on your website I cannot understand why you have chosen to deny my rights to have these procedures as I suffer with more than the requirements that you have presented.
• The panniculus hangs to or below the level of the pubis
AND
• The patient’s medical record documents that the hanging panniculus causes skin irritation or infection (resulting in pain, ulceration, superpubic intertrigo, monilial infestation, or panniculitis that is chronic, persistent, and refractory to medical treatment for at least a 3 month period. Examples of agents that may be used for conservative treatment are antifungal, antibacterial, or moisture-absorbing agents; topically applied skin barriers; and supportive garments.
I am currently scheduled to have a breast reduction (for which you approved) with Dr. Louis on
Very Truly Yours,
And the last one
I have enclosed letters from my PCP, Plastic Surgeon, Bariatric Surgeon, a nutritionist and my OBGYN. I reached my goal in March of 2006 and began maintenance on April 1st. I surpassed the goal of my Bariatric surgeon last year in the summer of 2005. I facilitate a weight loss surgery support group once a month and am committed to maintaining my weight loss for a life time.
I am asking for an approval of an Abdominalplasty and Medial thigh lift (which would include the removal of the excess skin around my knees) to correct these impairments due to excessive weight loss.
