Question:
PLEASE HELP ME!! I currently have Kaiser Mid-Atlantic insurance and they are just

determined not to pay for my abdominoplasty and arm lift. My employer offers NCAS-PHCS health insurance here in the DC area. Before changing over to another insurance company I would like to speak with someone who has successfully gotten PHCS to pay for their reconstructive surgeries.    — Michelle H. (posted on August 16, 2003)

August 16, 2003
Hi Michelle, Did that insurance pay for your gastric bypass?? If it did then I would be fighting them based on this...the only difference between reconstructive surgery and cosmetic surgery is that reconstructive is after getting over a disease and cosmetic is just for vanity purposes. Obesity is a disease recognized by the ama and your insurance company also if they paid for that first surgery! What stage are you at maybe you can do an appeal? I'm going thru this same thing myself but haven't gotten denied (YET) by bc/bs. The other thing that is very important that you do is to document the problems your having due to the skin issue. For example, if you have fungus rashes instead of getting the over the counter fungal cream, have your doctor give you something instead, that way when the insurance pulls your record(and they do!!) it will all be documented. Good luck and don't give up! keep in touch and feel free to email me at [email protected]
   — Lori M.