Panni Removal Exclusion

Hi! I usually am just a lurker here but I wanted to share some happy insurance news with you all.

My company's plan with UHC covered my bypass surgery but had an exclusion to all cosmetic procedures including the panni removal. I was denied twice so I decided to write my company's HR department. I worked for a well known computer company in their copier/fax division.

Well, one week after my email, I received the news today that because of my request, they are changing the exclusion for the panni removal for the entire country. I fought an exclusion and won.

Just make me finally believe that one voice can make a difference.

If anyone would like to see the letter, please let me know and I'll email it over.

Sincerely,
Hope

Hope,

That's fantastic!  I'm glad you fought it and won.

Congradulations!!!  That's wonderful news!  Makes me have hope for my case.  I would love to see your letter.

Thanks and good luck,

Lifedancer

I have United HealthCare and would love to see you letter. I am in the process of trying to get the panni removal. Can you please email it to me at [email protected]!

To HR Department: Hello! My name is Hope XXXX. I am an 8 year employee of XXXX. I am writing to you today to ask that you reconsider the intent of an exclusion in our health plan. On July 23, 2007, I had a Roux-En-Y gastric bypass surgery under our health plan. I began my journey on February 21, 2007 when I joined a medically supervised program at XXX Hospital to prepare for my new lifestyle after my surgery. This program has been very beneficial to my health, life and happiness. I weighed 560 pounds when I joined the program. Before my surgery date, I lost 92 pounds through the education I received from the Center for Weight Management and Bariatric Surgery. My current weight is 310 pounds. It has been an amazing 18 months and I thank you for including the option for bariatric surgery in our health plan. It has indeed changed my life and made me a happier and more engaged employee. I have lost an outstanding 250 pounds in this time. My entire work family has gone on the emotional rollercoaster with me and could not be prouder. The exclusion that I am writing to you about today is located in the Physical Appearance section of our Summary Description Plan. Our plan states on page 48 in this section: ■               a procedure or surgery to remove fatty tissue such as panniculectomy, abdominoplasty, thighplasty, brachioplasty, or mastopexy;   While I understand the intent of this exclusion is to not allow cosmetic surgery to every employee, I ask you to reconsider this exclusion in the case of a bariatric surgery patient.  The effects of excess skin and fatty tissue to a bariatric patient are tremendous. I currently have a pannus that hangs to my mid-thigh. If you are not familiar with what a pannus is, let me try to describe it. Since I have lost so much weight due to my dedication and surgery, my stomach skin has now loosened up and my apron belly hangs over my pubic area and half way to my knees. The pannus effects are more than cosmetic; they are truly functional and hygienic in nature. The need for a medically necessary removal is supported by my surgeon and my primary care doctor of 11 years. To give you a few examples of functional and hygienic issues that I encounter daily, I have listed some of them below. ·         Odor problems because of skin folds ·         Rashs and skin irrations because of moisture ·         Unable to exercise without pain ·         Needing assistance in shower to lift pannus ·         Back pain from carrying pannus weight ·         Psychological effects and Body Disturbance issues Not being able to complete my exercise without pain is a huge problem for me. The sway and weight of the pannus is very uncomfortable and puts strain on my back. The daily walking about the office causes the same discomfort to a lesser degree.  The need to cover at least the panniculectomy and thighplasty is evident to me simply because I am in this body. I am not asking you to remake the body of a bariatric patient completely. We simply need the tools to continue the new life that we have been given. I will never lose the fatty tissue of my pannus. My body has been overweight for too long for this to happen. My skin will never go back to its natural state before I started gaining weight at age 10. In fact, as I continue to lose weight my pannus will only lengthen thus increasing and aggravating the current issues as well as recreating new ones. This is true for a high percentage of bariatric patients. The psychological effects of not being able to have my pannus removed can be summed up quite easily. While I have lost almost 250 pounds, I will never achieve the normal life and health while I have to carry the weight of my past life around with me. It makes you feel freakish and non-sexual. To have a stomach that hangs down to the middle of your thighs, and possibility in the future to your knees, causes a huge personal psychology trauma to the patient. The depression that I believed was gone creeps back into my mind when I look in the mirror. Buying clothes is more embarrassing now then when I was heavy. The stares of strangers and children affect the patient every day of their lives. It is one thing to wear a long sleeve shirt to hide the excess skin on your arms but there is not much that can be done to hide the pannus in the middle of your body.   The cost savings to our health plan by allowing bariatric surgery is certainly a measurable asset. By electing to cover a single surgery, pre- and post-op care, you have decreased the risk factors for cardiovascular disease, diabetes, arthritis, high blood pressure and sleep apnea. All of these illnesses are co-morbidities and cost insurance companies thousands of dollars each year between doctor visits, hospital stays, rehabilitations for heart attacks, strokes, or broken bones and medications. These are just a few of the needs for patients with these co-morbidities. The chances that a bariatric patient will continue to need treatment for these co-morbidities decrease sharply. In most cases, the treatments are no longer needed because the body is healthier by having the surgery, education and training to live a better life. The savings for changing the exclusion are just as measurable. The future psychology health of the patient and physical ability to continue to lose weight via diet and exercise are affected by not having the pannus removed. This can lead to weight regain and the possibility of needing a revision to the gastric surgery. Please consider covering these surgeries for any bariatric patient. If needed, set a minimum weight loss to achieve this coverage. Blanket exclusions are huge disadvantages to your employees and their health. This also is a disservice to XXXX as a company.   A healthy and happier employee takes less sick time from the company. Therefore the services that we provide to our customers are increased because of the availability of employees with positive mental attitudes. There are several large insurance plans that do cover these so-called “cosmetic” surgeries for bariatric patients, even state health plans will cover a panniculectomy for a bariatric patient who meets specific qualifications. In the spirit of our philosophy, I ask you to consider changing the intent of this exclusion. I sincerely appreciate your time and consideration to this matter. I am always willing to answer any questions you have on this subject.