Question:
Help...How do I get the insurance company to pay for this???

I had an Open RNY March 2000..I went from 475 to 175 in the two years. Now I have this skin problem. The insurance denied the claim and I have a second level appeal on May 8th at 2:30p.m. I get to present my case in 20 min. before thier review board. Any suggestions????    — Becker417 (posted on April 25, 2002)

April 24, 2002
Congratulations on a great weight loss!! I'm pre-op, but I remember reading a couple of responses to this question in the past. If you have a medical record of rashes or hernia and haven't presented that, bring it with you. Others said they took pictures of themselves with them, because it spoke volumes about needing the surgery. This is a humbling experience I'm sure, but if it can get you what you need go for it. You will never see those people again. God Bless.
   — Cheryl S.

April 24, 2002
First of all, congratulations on your amazing success! You might want to check out Sue Barr's website at www.mygastricbypass.com. She went from 500 pounds to about 165, and has posted fantastic appeal letters for plastic surgery and even photos. She's an incredible inspiration! Good luck!
   — Leslie F.

April 24, 2002
Dennis, I think the key will be to convince the insurance company that plastic surgery would be "reconstructive" rather than cosmetic. What health problems are you having because of your excess skin (i.e. rashes, trouble walking, etc.) Then talk about how the excess skin is bothering you on an emotional level (how clothes don't fit right, etc.) Good luck.
   — Terissa R.

April 24, 2002
Dennis, If you only have 20 minutes, start with refuting the reasons for the denial. Have you seen the doctor for any medical problems associated with the excess skin? Documentation of those visits should be presented if it hasn't been yet. Also, I agree that pictures are a good idea. Supporting letters from doctors other than your PCP are also a good idea.
   — garw

April 25, 2002
I had to take my appeal for surgery to that step too. I was told in advance that there were a few rumblings about this being cosmetic surgery. I took my girlfriend with me who had surgery done the month before. Where i didn't have the guts she pulled up her shirt and showed them her scar (open with 35 staple scars)....hehe the approved me and i had the approval letter within 2 weeks. So, as much of an embaressment it is maybe showing your skin will make them see that you really do need this removed....good luck debbie
   — deborah D.

August 20, 2003
I went for the PS consult and I had a rash, along with a hanging panni and I had just been diagnosed with fat necrosis (hardening of the fat cells). I was approved in 1 day by Cigna HMO. Good luck.
   — Rhonda W.

October 2, 2005
Finally...I got my "Tips for Getting Your Plastic Surgery Approved" worksheet on my website. It will help individuals who have medically necessary issues get their plastic surgery covered, at least in part, by insurance. Check www.drlomonaco.com under "Patient Resources"
   — DrL

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