Plastic Surgery: Is appeal with it?

Wendy H.
on 1/2/05 2:16 am - Omaha, NE
A little background: Lap RNY 05/05/03, 325lb, down to 190lb. Dr. Dwain Rogers from Mercy Hospital (Council Bluffs) performed the procedure. My insurance is UHC - Share Advantage. I'm trying to plan a wedding this spring, and will lose my coverage when "I do". Dr. Rogers referred me to Dr. Nagi Ayoub with Bergen Mercy (Omaha). My first consult with him was 10/07/04. The nurse told me it would take between six to eight weeks to hear back from the insurance company. I called her again on 12/07/04 and asked if they'd heard anything. She called back later and said the insurance company siad "It was still under review". I thought perhaps they were delaying a decision until the beginning of the fiscal year. On 12/27/04 I received a letter from UHC saying the procedure was denied "because it would be performed solely for cosmetic reasons." The date of denial was 12/15/04 - oddly enough, a week after I called the surgeon's office. I find that...interesting. The letter offers me the opportunity to appeal, if I contact them within ninety days. Has anyone done this and succeeded? Is it worth delaying my plans still more, and hoping a new insurance company will look more favorably on my case? Should I try another plastic surgeon?
nshimmel
on 1/2/05 7:57 am - Auburn, NE
Did your Surgeons office send letters of recommendations for the surgery? Did they send pics? Did your Personal Doctor write a letter of recommendation? Do you have back or neck problems Ect?? Is so send all this information to the insurance company and let them know. The more documentation that you have the better. Show problems as to why you need the tummy tuck. I think that you would probably have better luck getting the Insurance company that covered your WLS to cover it than a new one. My surgeon has told me that I need to document all problems as I will be looking into a TT later thsi year. Nick
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