Final Appeal Advice needed!

karlahill
on 7/27/06 3:42 am - Knoxville, TN
Here are the facts! I had Open RNY Feb 04. It was very succesful. From 335 to 145 at 5'10 the effects were dramatic. At this time I have filed and been denied twice now by BLBC for the skin reduction on my thighs and tummy. They state that my photos do not show an "adequate" overhang. For the last 2 years I have fought countless vag infections, irratations, pain, pinching, and unable to carry on a normal sex life. These are not cosmestic. At the age of 23, I was told my skin should not be a problem, well guess what it is! I asked them to include in their denial, to define excessive, and it states causing hernia or skin infections. All of my problems have been documented. I feel I have done everything on my end, every itch I went to the doctor for, I've used the medicines and creams and pads. Any suggestions or links/documents that may assist me to appeal to my husbands employer, IBM. This surgery was the best thing I could have ever done for myself. I am so ready to complete this process and move forward, as many in my same shoes. Still feeling trapped in this "Fat Skin"! while a insurance company tells me it's not that bad! Of course my skin isn't as bad as someone whom has lost even more weight. I think new standards and guidelines need to be set, we are not all created equal, and shouldn't be denied based on photos and personal opinions, measurements and weights, and acutal location of body parts. When the nurse finished the photos for the insurance, she says "well at least your face doesn't have to be in them". It was a big smack in the face to hear denied twice now. However I will see it through to the highest! Thanks everyone, I have 14 days left to appeal! [email protected]
Susan J.
on 7/28/06 10:14 pm - Madison, TN
After a 190 lb loss just how much of an "overhang" do they want?! Since you are now less than half the size you used to be, I would think you would have more than enough excess skin to qualify no matter your age. Congratulations on your loss!!!!!!! I hope you can get the insurance company to come to their senses now. Good luck
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