Question:
I am one year post-op and have lost 140 lbs. from open RNY. I am 15 lbs. away from

goal. I sent letters from 4 doctors as well as photos to my insurance company for abdominoplasty and was denied. I need help with an appeal letter and any advice. I have BCBS, but may be switching to Aetna in a few months. I'd like to get it done before I switch. Need a good appeal letter. Thanks so much!    — Marybeth O. (posted on January 30, 2003)

January 30, 2003
If you email me privately, I'll send you a copy of mine.
   — vitalady

January 30, 2003
I am no expert.. But I have heard that insurance companies consider abdominoplasty cosmetic.. Your doctor may have to write it up as a panniculectomy which is considered removal of excess skin. Abdominoplasty involves a little more..which where the upper ab muscles are also tightened to give a more defined and shapely look...maybe this will help.... Good luck and congrats on your great weight loss!!
   — JoAnne G.

January 31, 2003
I had BCBS.. FIRST NOTE: SKIP THE LEVEL ONE APPEAL... (They dont tell you up front you can do this... but you can ) Its a waste of time. When I submitted my TT w/hernia repair at level one it was "denied ... by a 'Urologist and an LPN". It went to "Level two... they didnt get 'any more' medical information from me except a nasty letter and it was approved at Level two. This was for an Admonioplasty. (sp). In fact, I argued with her I didnt care what was done a TT, Admon or panni just needed this skin 'off'. It was approved. In fact, unfortuntely a little to late; and i had to "re apply' LOL to Atena... Which I used my BCBS 'approval' letter ... Atena approved it.. At level one.
   — star .

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