NEED HELP. INSURANCE DENIED PLASTIC SURGERY.

doneO.K.
on 8/23/07 11:06 am - ST.LOUIS, MO
I HAD SURGERY MAY 5TH 2005 AND I  HAVE ALOT OF LOOSE SKIN AND MY BREAST IS AMOST DOWN TO MY KNEES. I WROTE A NICE LETTER TO MY INSURANCE COMPANY AND HAD A CONSULTATION WITH MY PLASTIC SURG. TO HAVE A BREAST LIFT AND A TUMMY TUCK WELL MY G.E.H.A A INSURANCE A.K.A HEALTHLINK DENIED IT SAYING IT'S NOT MEDICALLY NECESSARY THAT I NEED IMFORMATION ON BACK PAIN PROBLEMS.ETC.ETC RASHES FROM A DOCTOR.. WELL THE PROBLEM IS I NEVER SEEN A DOCTOR FOR MY PROBLEMS SO I HAVE NOTHING FROM A DOCTOR. BUT I HAVE HAD RASHES AND I DO HAVE ALOT OF BACK PAIN, CAN SOMEONE HELP ME I WILL APPEAL THIS EVEN THOUGH I HAVEN'T WENT TO A DOCTOR FOR THESE PROBLEM WHAT INFO CAN I SEND THEM TO GET APPROVED. HELPPPPPPPPPPPPPPPP!!!!!!!!!!!!!!!!!!
Kayla B.
on 8/24/07 9:13 am - Austin, TX
you're going to have to start getting these things written down by a medical professional.  See your PCP to talk about back pain and get a prescription for the rashes.  Make sure he/she is thorough with what they write down.  Eventually he/she may even be able to write a letter of recommendation that these procedures are medically necessary.  I'm not sure you'll have much luck with a breast lift; might have better luck with a breast reduction.  Be sure to refer to is a reconstructive surgery, not plastic surgery, when dealing with insurance.  Also, please some writing in all caps, it's very difficult to read :(
Full of Life
on 8/28/07 7:13 am - Broken Arrow, OK
Nope, no real way to appeal this. Just start over. Go to the doc and get it all documented!!!! Then resubmit in a couple of months.  Keep your chin up - there's still a lot of HOPE for it to come!!

Laurie
I can do all things through CHRIST who strengthens me

 

RNY 5-19-05      
hernia repair/tt 4-10-06
BW: 262 lbs     GW: 140 lbs     CW: 126 lbs

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