Question:
What did you do to be medically approved by your insurance for abdominoplasty?

   — Dawn M. (posted on June 24, 2004)

June 23, 2004
My INC denind me bt medicade approved it bt the dr sent pics of me in to them of all the skin that is hanging on me and told them with it I would be delevpoing rashes and back problems not sure what all else he had on their Take Care Huggs Beth
   — wildbrat

June 23, 2004
I wrote a LONG detailed letter explaining how the extra skin contributed to my frequent rashes, back pain, etc. Went onto explain how the surgery would be strictly reconstructive. You have to make sure that your plastic surgeon submits the correct CPT code for an abdominoplasty not just removal of the skin. Take Care
   — Michelle H.

June 23, 2004
When you write an appeal letter, state your symptoms, and then state what you have done to try to alleviate them. Read your summary plan description and see what it says about reconstructive surgery. Define reconstructive versus cosmetic using verbage from the American Society of Plasctic Surgeons, and the American Medical Association. (check the web sites). They also have position papers and statements, and I included the statements on abdominoplasty and skin redundancy with my appeal letter. Stick with facts, and don't make your letter sound "whiney". E-mail me and I will send you my appeal letter and the position statements. Good luck!
   — koogy

June 24, 2004
My plastic surgeon's office handled the approval request with my insurance, and I was approved for a panniculectomy (skin removal, but not muscle-tightening) on the first try. At my initial consult with the surgeon, I explained the rashes I had had (for which I had sought treatment and prescription cream from my PCP), the back aches I now get from time to time, and the limitations on mobility (can't run or ride a bike, for example). I assume the surgeon included those in his request, but I know what really convinced the insurance company were the photos the surgeon submitted (they wouldn't approve until they saw those). There was no denying the vast amount of excess skin.
   — Vespa R.

Click Here to Return