Abdominoplasty surgery denied by medical neccessity

Help! Where are those sample appeal letters located? My insurer BCBS TRS Activecare has denied my abdominoplsty. I am extremely discouraged. Someone please help. Also, any information that would help the appeal process please forward to me.

Panni's are harder to approve because they consider them comsmetic. What you need to do is look at your policy and see what they consider reconstructive and make sure your doctor's recommendation shows that you meet their criteria. Document all problems with rashes, back pain, decreased mobility and submit supporting letters from other doctors if you have treated with any for any of those symptoms. Keep fighting and good luck Gary Viscio www.obesitylawyers.com

Did you get a copy of the "utilization review" guidelines that your insurance company used to deny your request? If not, call them and have them send you a copy. (It's your right under ERISA to receive copies of anything used to make a decision on your claim.) Once you see the guidelines, you will have a clearer idea of what information they are looking for. Different companies have different guidelines. Some companies follow the American Society of Plastic Surgeons recommendations pretty closely, and others may state that there needs to be clear documentation of physical impairments. Just because you have back pain or a rash, doesn't necessarily constitute a physical impairment. You need to know what you are specifically fighting for in order to support your appeal. Fight the good fight! Roberta