Appealing Panniculectomy Denial

My situation is a bit different from what I've been reading here but I hope I might find some answers.  Brief background:  I weigh 285 lbs, have extremely high cholesteral, high blood pressure, insulin resistant, back pain whi*****ludes a slipped disc, a hernia that was called an umbilical hernia by the radiologist but an incisional one by my Dr., and I am not able to exercise for any longer than a couple of minutes due to my extremely large and dropped abdomen.  I have had a large abdomen my whole life but since my hysterectomy 3 years ago, it has gotten much, much worse.  So much so that my quality of life has really been affected in many ways...back pain, can't exercise, bend over, put my shoes on, find pants to fit, hygene problems....the list goes on.  I have United Healthcare and had an appointment with a plastic surgeon on my insurance list.  I'm not exactly sure what he sent into them (and I need to find this out), but there were pictures taken and I know those were sent in.  I received a letter from UHC stating the typical this is a cosmetic procedure and these are not covered by your plan.   Where I'm at now is...I know I can write a good appeal letter stating my case but I'm clueless as to what exactly I need to send in with my letter and the format my letter should be in to be effective.  I'm not wanting a weight loss surgery-I'm wanting a surgery to remove the huge amount of fat that stops me from being able to exercise so I can attempt to lose weight.  A panniculectomy, at my current weight, is anything but a cosmetic surgery.  I've seen pictures of obese people who have had this surgery and it's no prettier a site than a picture of me with my huge abdomen!  However, there is no possible way I will ever be able to lose the necessary weight as long as I have this physical barrier.  I realize even if I do have the surgery, weight loss will be a huge struggle for me trying to do it on my own.  But at least I can give it my best shot with eating right and exercising and if I'm still having problems, then I could consider an actual weight loss surgery. Any info you all can provide me would be greatly appreciated!

Wow Judy, this is a really good letter!  Thanks so much for sharing it with me.  I am going to save it to my computer and use the parts I can in my letter.  One thing I'm needing to know is the use of the word abdominoplasty.  I've read the use of this word is associated with plastic surgery and panniculectomy is best used for reconstruction in the eyes of the insurance companies.  Is this true?   I think it's just great you were able to have surgery!  How are you doing?  Have there been any surprises or has everything pretty much gone as you had planned? Again, thanks so much for sharing your info with me.  I really appreciate it.

Kc the use of the word abdominoplasty really isn't considered one or the other.  It is how it is put on paper that the insurance companies care about.  If your PS says cosmetic, then the insurance will not cover it..however, if the ps puts reconstructive abdominoplasty for medical reasons such as rashes, boils, skin intertrigo, thoracic and lumbar back pain etc, then insurances should consider it a medical necessity and cover it.  Some surgeons will only put in for a panniculectomy, because insurances tend to cover those more often.  However, my surgeon wrote the letter for an abdominoplasty and panniculectomy and they approved me on that first letter.  If you wish to see his letter, please let me know and I can type it up for you. I am doing pretty good right now..I had my TT June 19th, and i am 12 days postop today.  Only surprise for me was the swelling in my mons area..owie.  It is a rough surgery to go through and the recovery has been slow.  But overall, im making good progress. good luck JudyB

Judy, I need to check with my PS and find out exactly how he worded it in his original letter.  I know during my consultation he was calling it a panniculectomy.  After reading about both, I feel an abdominalplasty is more of what I would want.  However, since I have not been able to lose any weight mostly due to the large panni, I think my PS wants to do a panniculectomy.  He mentioned me having lapband down the road and then needing more reconstructive surgery after I was to lose a substantual amount.  The way I presented it to him, and this is how I truly feel, is my quality of life is greatly suffering and in order to improve it, I need to be able to be mobile again.  If it's not too much trouble, I would very much appreciate seeing the letter your Dr. wrote. I don't doubt for a second you're in a lot of pain!  But glad to hear you're hanging in there.  The hysterectomy I had 3 years ago was one where I was cut open and while worth it, it was a tough recovery.  I hope you continue to heal and get to a point of feeling great!

Hi Judy...I was wondering if you might be able to send me a copy of the letter your Doc sent in to your insurance company...I am just starting my journey into PS and would like to have as much information as possible and would like to get the termonolgy correct...Any help you could give me would be great... Jannine 357/163/157

HI Janine Check your OH messages.. hugs JudyB

Does anyone have an appeal letter for a panniculectomy/ abdominoplasty that they would like to share?

Hello Mrs. Judy B. would you please send my a copy of the letter. I was recently denied with UHC and I would like to appeal and don't know where to start. I would love for them to approve my first appeal. I would great appreciate it if you can help me out. UHC covered my gastric but said panniectomy/ abdominal plastic is not covered! HELP PLEASE THANKS 

Did you get the letter? Were you approved?