Question:
NEED HELP QUALIFYING FOR PLASTIC SURGERY
I 13 months out I reached goal at about 8 months out I lost 97lbs. my wls says the ONLY weight I have left is my massive hanging pannus(25lbs.). I was denied the first go round my wls submitted my request with no pcp notes. I was denied due to no documentation stating functional impairment. Although my pannus does definately hang below my pubic area and I am now seeing a chiropractor for back pain(started this week). I see my pcp on the 21st. and although the skin on my stomach does tend to from the slightest scratch. and hygiene is a chore I do NOT have and rashes or infections under my pannus... Has anyone EVER gotten approval without rashes and /or hernia?... HELP!!!!!!!!!!PLEASE.... Trust me if I knew how to give myself a rash I WOULD...please don't judge me by my last statement if you had 25 pounds of hanging skin and fatty tissue you'd be willing to do ANYTHING to get rid od it too. thanks for any suggestions — tracy W. (posted on September 9, 2004)
September 9, 2004
I had my Doctor call the number on my first denied letter. He was gone for
5 minutes and said they approved it. He explain all about the rashes and
back discomfort even thoght their were a few remarks in my file. Talk to
your PC and see if they are willing to help you. Good Luck
— sarah C.
September 9, 2004
Send me an email and I will send you my appeal letter and the positions
statements of the American Academy of Plastic Surgeons on redundant skin
and abdominoplasty. I got around an exclusion for "panniculectomies
and similiar surgeries after weight loss surgery", and had my
abdominoplasty denial reversed by a panel of physicians. I only had about 6
lbs of tissue removed, but - wow! My back no longer hurts! Never had enough
of a pannus to have a rash.
P.S I will send my letter and the statements to anyone else who wants them,
just email me!
— koogy
September 10, 2004
I got approval without any rashes etc. but I also have long standing
history of lumbar degenerative disc disease. It was a well written letter
by an orthopedic surgeon that secured my approval of a full extended
abdominoplasty done in 1 stages - below the belly button and then above to
remove the large hanging lumps on the back etc. Strange anatomy prevented
it from being done in one surgery like most people and insurance agreed.
<p>I just caution you that I sincerely doubt you have 25 lbs of skin
to remove, but then again I haven't seen you. I do not know of anyone who
lost in the 100 lb range that had that sort of skin and fat removed. I
lost 230+ lbs before PS and I still only had 19 lbs removed in the first
surgery and about 3 in the 2nd. There are very few SMO that even run 25
lbs, so don't get your heart set on that much coming off. Your PS may have
been very oversealous in their estimate. No matter the amount it will be a
huge and welcome improvement and worth any pain and discomfort.
<p>I have no recipes for causing skin problems and personally would
not go there, but that's me. I have significant hanging skin on my legs
but the bottom line is it can only be called cosmetic so I won't even
bother to submit to insurance. If they did not approve the lateral thigh
portion of my lower body lift, then they won't approve the legs. I don't
need the emotional ups and downs of fighting with insurance over something
I cannot say with a straight face isn't cosmetic. The same with my arms
and breasts - cosmetic all the way. It is a bite to deal with the
financial aspect of these remaining surgeries but I will do them as I am
able to afford them. Good Luck in your quest!
— zoedogcbr
Click Here to Return