De-nied!

I just got off the phone with UnitedHealthcare and was told that my request for authorization for plastics (panniculectomy and gynocomastia/ male breast reduction) has been denied because it is not covered under my plan...I will get a letter explaining more. and will talk it over with my surgeon's office to determine how to appeal it, but for now it is denied. I told myself and others that I won't be disappointed, but right now I am. I'm very disappointed. It took ten months just to get to this point. How much longer am I going to be dealing with this! My hunch is that I'll be dealing with it until I save up enough money to visit Tijuana...I'm still hopeful though that I'll find a way to get it done here.

You know what, you can fight this!  As far as the coverage they are just looking at it from a physical aspect and as plastics.  You just need to prove a stronger case with it being medically necessary!  They love that term.  Talk in detail about rashes, pain etc, take pictures and tell them they are violating your patient rights and give as many laws to back that up as possible.  Approach it hard and strong, more so than you already have.  It is covered if its a proven without doubt that its a medical condition not just plastics.  You can do this! 

It might be a good idea to find out if your carrier is the one  saying it is excluded or if the issue is the plan that your employer bought from the carrier is the one with the exlusion. If the issue is with your employer than I am not sure there is anything that is appealable even if you can prove it is medically necessary. Good Luck