Question:
HELP!!!!! I WAS DENIED. HOW DO I APPEAL AND WHAT ARE MY NEXT STEPS`

I WAS DENIED DUE TO IT BEING COSMETIC REASONS. I HAVE SO MUCH SKIN AND IT IS STARTING TO STINK UNDER MY WRINKLES OF SKIN.... HELP...... WHAT DO I DO NOW. MY BOOBS ARE SAGGING HORRIBLY, AND I WANT THEM LIFTED, AND THEY ARE GIVING ME SEVERE TROUBLE WITH MUSCLE STRAIN, I CONSTANTLY HAVE CHEST PAINS DUE TO IT. I NEED THIS SURGERY...    — TONYA B. (posted on February 23, 2003)

February 23, 2003
First find out if the PS who sent in for approval documented the reasons this is medically necessary. Also, find out if your insurance will cover if it is. If they don't cover the excess skin removal no matter what, then you probably don't have much recourse. However, if they didn't get documentation of any physical problems you're having because of the excess skin, make sure they get that. That is usually the difference between it being considered cosmetic and it being considered medically necessary. Also, if your PS didn't send that in, have you documented it through your PCP? Have you gone to him/her because of the smell (which is probably due to yeast infections), visited the doc for the back pain because of the sagging breasts, etc.? If not, start doing that now. That may help you get approval down the road.
   — garw