Plastic Surgery Time

Hello All Im ready to have plastic surgery. Can anyone recommend a good surgeon? Tell about their experiences with the insurance company, did you get approved? appeal letters etc? I know it will be a long road...but any help/advice would be wonderful! Thanks Sylvia

These were posted on another board last week. I will e-mail you the other info I received. Hope it helps. Good Luck Phenom ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ I have received quite a few requests for copies of the letters, so I will post them. Take whatever it is you need, and mold it for your own. IT MAY BE ALITTLE GRAPHIC FOR SOME. DO NOT GIVE UP! I do not know which one they overturned as I had already submitted for independent medical review and I was approved before that could go through, but keep trying. They want to see you persistent. YOU CAN COPY AND PASTE THIS ALL INTO A DOCUMENT AND PRINT IT OUT. Take care. Have fun! FIRST LETTER: I am writing this letter advocating medical necessity for abdominoplasty. In October of 2004, I underwent bariatric surgery. I had AGB adjustable gastric banding (LAP-BAND). Over the course of the past almost two years, I have lost over 90 pounds and have resolved most of the health issues I have suffered from because of my weight. Although I am grateful for the privilege to have had weigh loss surgery, I am now plagued with other issues. During the course of my weight loss journey I have been happy to shed pounds, but this has come at a cost. I suffer from recurrent and agonizing rashes, boils, and infections, due to the excess skin on my abdomen. In addition, the lingering skin pulls constantly on my back causing chronic pain so much that at times it has rendered me immobile. I have had to take off work, because of the pain. I have been under the continuous care of a dermatologist and a chiropractor throughout. I have been on a variety of medications and antibiotics, as strong as prednisone for my skin infections, as well as in-office cortisone injections. The habitual use of antibiotics has caused me yeast infections as well. For my back pain, I have to wear a back support regularly. While this alleviates some the pain, I have been advised to not wear it daily as it may continue to weaken my already strained back/spine and surrounding muscle. I often feel stuck because I have traded one set of problems for another. I have better overall health because I have lost weight, yet I am unable to fully enjoy and reap the benefits of my hard work because of constant pain, irritation, and strong antibiotics. I have asked for letters confirming my status from both my chiropractor and dermatologist, and those will be forthcoming. I am asking that you consider my request for abdominoplasty medically necessary, so that I can be alleviated of these symptoms and begin to enjoy a healthy, normal, pain and medication free life. I appreciate your taking the time to consider my petition, and thank you in advance for your prompt response. SECOND LETTER: This letter is in response to my denial for abdominoplasty with Dr. Glafkides. I am currently at a weight of 195 pounds, having lost just under 100 pounds through bariatric surgery. I had surgery in October of 2004, and at 19 months out, I continue to be grateful for the surgery because it has allowed me to gain a health and lifestyle that could have been cut short without medically necessary intervention. However, the problems that have been associated with my obesity still persist, even after losing a large amount of weight. Unfortunately, because of my obesity and rapid weight loss, my skin elasticity has been destroyed. I have been left with a 10-15 pound mass of skin hanging from my abdominal/pannus area. Removal of this last amount of excess skin would put me at my goal weight, if not beyond. The reason I am requesting an abdominoplasty is so that I would be able to move without constant pain from the tugging and pulling on my back and chronic skin infections as a result of my condition. I now suffer ongoing rashes in the folds of skin in the abdominal/pannus area as documented by my dermatologist who has followed me for almost two years. When they occur, they last 2-4 weeks, ooze, and are extremely painful. The area becomes blistered and raw. I have self medicated with OTC topical medications/treatments, such as Extra Strength Hydrocortisone, Antifungal creams, Miconozale (sp), Medicated Powders (Zeasorb AF, Mexana, Gold Bond Extra Strength). I also blow dry the area after showers, etc., but to no avail. If I have a particularly stubborn boil or blister, I usually end up having in-office cortisone injections. In addition, to everything listed above, I have been on several antibiotics regularly. I now take two oral antibiotics on a daily basis. The medications I am on cause my potassium levels to go very low. I also take an occasional, but regular low dose of prednisone for my skin, which over time can cause several health issues, (i.e., diabetes) as you should already be aware of. I also use Loprox Gel and Wash when necessary. Although this is helpful, because of regular antibiotic treatments I suffer yeast infections, both on my body and vaginally. I currently treat my back pain, with regular chiropractic visits. In fact, I also had my chiropractor submit a letter of recommendation. With my letter I will submit a positive orthopedic test. He sees my lower back pain as a persistent issue that can be alleviated by removal of the excess skin. I have to overcompensate when I walk, and the extra skin hanging from my abdomen places additional stress on my lower back, knees, and legs. He has suggested specific exercises which I try to be as faithful and consistent as possible, but has done little to relieve my pain. I often go suffer back pain and/or blister/boil irritation from the skin causing friction from rubbing when I workout. Exercise is a very uncomfortable experience, even for short periods of time. I wear a back support brace, girdle, and support panty hose regularly. I can not sit up or stand for long periods of time. I am a single parent, student, and I try to work regularly as not only does pain prevent me from working full time, but I also have to take many days off for the frequent doctor's appointments, when I suffer from severe pain or breakouts. I have a 5 year old daughter who can only depend on me to be her sole provider and caretaker. I am trying to take the best care of (her AND) myself in every area of our lives. These constant nagging issues put a damper on what should be joyous responsibilities. It's hard to play with her or care for her when I am incapacitated from back pain, or my body irritated by skin infections. I am forced into a vicious cycle of treating one thing after another. To be blunt, everyday living is hell for me because, if it's not one thing going on, it's another. I suffer everyday as I juggle between back pain and pain caused by skin and/or yeast infections. The reason for this letter was to take the time out to help you understand what it is like for me to live on a daily basis. I am hoping that you look into my case (with all my prior documentation) with a new sense of urgency. I still suffer from problems as a direct result of my disease of obesity. I feel as though if I were request reconstructive surgery as a result of cancer (like breast cancer), that you would have no qualms with deeming my approval medically necessary. The problems I have are no less of an issue, really. I pray that you consider me not just as another number, but as a real person with real problems, and show mercy, by reconsidering your decision. THIRD LETTER: I am writing to day to submit a second letter with a few photographs I have taken over the course of the past year. I have taken time out to document the different skin issues I suffer from. Unfortunately, the paper quality isn't the best, but you will still be able to see the problems. I would be more than happy to submit the images by email, should someone provide me with an email address to send them to. The first page is an example of the boils I suffer from in various places on the abdomen and under the pannus. These boils ooze, and are painful. They tend to be stubborn, and even with antibiotics, the recovery, takes approximately 2-4 weeks. The other scars, you see are the result of past boils that have healed over leaving scars on my skin. The second and third pages are pictures of rashes and skin irritations that are also recurring. They often develop in the folds of my excess skin as well as under the pannus. The rashes are red, and easily irritated. Anything that even mildly binds it (such as elastic from under garments, or the back support provided by my chiropractor, that I have to wear regularly), or sweat from when I am able to exercise, worsens the irritation. The rashes are relieved with a prescription of Clobetasol .05% and/or Loprox 1%. Also, on the fourth page shows evidence of yeast and/or bacterial infections that reoccur inside and immediately around my navel area. It will sometimes leave evidence of oozing, and also regularly has a foul odor. On the fourth page is evidence of a boil/abscess (from just last week) that came to a head and has started to heal. This occurred in the folds of my skin under my pannus. I am also showing a picture of my pannus truly hanging below the pubis area. ? I am less than five pounds from having lost 100 pounds. That can be achieved before the official 30 day review process is complete. ? I can show, and have shown evidence of ongoing skin irritation through doctor's notes and photographs. I am 19 months out form surgery and will be 20 months out from surgery by the end of this 30 day review process. ? I have also submitted letters from doctors which I have seen regularly over the course of more than a year. ? I continue to see them regularly once a month or once a week respectively (you can look through my insurance claims to confirm this). ? My pannus hangs at or below the pubis area. I feel it could be considered a mere technicality that I was denied my request. I meet more than half the criteria to be deemed through Blue Cross Insurance to be officially "medically necessary." I met well over half the requirements necessary already. I clearly have shown proof that I am experiencing an extreme hardship, due to my excess hanging skin. These problems I agonize over will either stay consistent or worsen as time passes. Waiting for a specific time period to pass, when I suffer significantly now, would only ensure that I will continue to suffer for another six months, for something that is practically inevitable. Approving my abdominoplasty now, would ensure that I can work to improve my life sooner rather than later. I implore you to review my case, and make in independent decision based on what you see and the documentation provided. I will also continue to submit pictures as other issues arise. If you require ANYTHING else, please contact me, and I would be more than happy to provide it. I appreciate you taking time to review my concerns. Thank you. INDEPENDENT MEDICAL REVIEW: To Whom This May Concern: I am writing letter to appeal to the Independent Medical Review Board. I am a 29 year old female. In October of 2004 I had bariatric surgery. I am currently 195 pounds, 98 pounds from my highest weight of 293, where I was when I started my weight loss surgery journey. I am a single mother and virtually a full time student, I also work full time. Over the course of the past almost two years I have been able to successfully lose over 80% of my excess weight. It has been a long struggle that has allowed me to regain my internal health. I am no longer borderline diabetic, and will soon not have to take blood pressure medications. I no longer suffer from shortness of breath, and my energy level has increased significantly. In this aspect, I have been triumphant. Although I was educated, and I personally researched to make myself aware of the challenges of losing such a large amount of weight, nothing could prepare me for the challenges I was to face as a "side effect" of losing the weight. My first experience with chronic skin irritation started in late February of 2005. I developed an abscess in the folds between my breast and abdominal area. It took several weeks before it would come to a head and I experienced extreme pain and irritation. I made my first appointment with my dermatologist (Dr. Peter J. Panagotacos) who immediately put me on my first round of antibiotics. I soon developed more boils and abscesses in other skin fold, such as under my breasts, groin, and pannus. I had ongoing dermatology appointments every week. My prescribed medications got stronger, and were soon followed by cortisone injections. I also have had several fungal infections in my navel (and surrounding) area, under my breasts and pannus. To date, I continue have regular office appointments every six weeks, and I continue to take two antibiotics daily (Doxyclycline and Spironolactone), which cause me to have recurrent yeast infections. I treat those yeast infections with medications, such as prescribed Diflucan and Miconoazole 2%. While continuing to suffer from these skin conditions, I soon found that I started to suffer from severe and incapacitating back pain. In August 2005, I made my first appointment with chiropractor, Dr. Michael Abney. I initially started going 3 times a week, and often had to have someone to take me to and from appointments. The pain was so severe that I would shake and cry. I have had to take off of work often because of my inability to sit or stand for long periods of time. I wear a back support on a regular basis. I continue regular appointments once a week, as my health insurance permits. In fact, Dr. Abney recently submitted for an extension to continue with much needed chiropractic treatments. In the meantime, I continue to suffer from the problem of having redundant skin. It is difficult to maintain normal activity which I address in my letters submitted to the insurance company. I am trading one set of health problems for another, and while it may not seem life threatening, I am being a denied a right to live a normal and comfortable life. My weight loss success has been thwarted and plagued by debilitating back pain and chronic skin disorders, and my complaints are being disregarded and are not considered to be of importance. My insurance plan considers panniculectomies and abdominoplasties medically necessary only if of ALL of their criteria are met. As of today I have met all but two, and my situation should be reconsidered. -Documentation of panniculus hanging below the pubis. My reconstructive surgeon has submitted several photos documenting this as well as I am submitting some of my own. -Documentation through medical records of the following: Recurrent or chronic rashes, infections, ulcers, etc, that do not respond to conventional treatment for a period of three months; OR difficulty with ambulation or interference of activities with daily living. My dermatologist, chiropractor and GYN, have submitted letters noting observance of my chronic skin irritation, rashes, fungal infections, and I have a copy of my positive orthopedic test, from my chiropractor, and recent request to continue chiropractic care. I am also submitting several photos documenting rashes, boils, and abscesses. -If patient has had bariatric surgery must be at least 18 months out, have lost over 100 pounds, and have maintained stable weight for 6 months. To date, I am over 19 months out, and have lost 98 pounds. I have not maintained a stable weight for 6 months. I have less than 20 pounds to lose before I am at my goal weight. 10-15 pounds of the remaining weight is due to redundant skin, and my hanging pannus. My appeal is asking that my insurance reconsider their denial for several reasons. I have achieved more than half of the requirements they are asking for, and honestly the two I do not meet are qualitative, subjective, and questionable. Although I understand, there has to be a basic standard set for approval, would a person who only fits ALL of the criteria be the only type of person that would suffer from these symptoms? My discomfort is being discounted because of mere quantitative numbers. In consideration of where I am on my journey, a loss of two pounds as well as maintenance of weight at six months should not suddenly make things "count." In fact, in my particular case, it can only make matters and my life worse, drawn out, and considerably more miserable. The side effects and damages done to my body from my disease of obesity, are being ignored, discounted, and denied. I could understand if I had little or no problems with my weight loss, or that I had not reached even the half way point in my weight loss, or I did not meet over half the criteria necessary for surgery. But I have, and I am a real person having serious debilitating issues caused by my excess and hanging skin. It seems as though the idea of reconstructive surgery is biased. If I were writing to request breast reconstruction after surviving breast cancer and a mastectomy, I would be approved with little problem. Perhaps the only prerequisite would be to have had a mastectomy. The concept of obesity being a disease has been overlooked. It is real, and just as disease is defined [n. a condition in a living plant or animal in its body or one of its parts that impairs the performance of a vital function; or a harmful development.] is exactly what I suffer from as having been diagnosed as obese. While I am not making light of any surgery, I feel that in addition to the conditions I suffer, the definition of reconstructive surgery (especially one requiring reconstruction as a result of disfiguring from disease) has been ignored, so I recall: Reconstructive surgery Definition Reconstructive surgery is a type of plastic surgery. It is performed to reshape abnormal structures of the body to improve function and appearance. Reconstructive surgery is a different kind of plastic surgery than cosmetic surgery, which is performed to reshape normal structures of the body to improve a patient's appearance and self-esteem. Purpose The goals of reconstructive surgery are to reshape abnormal structures of the body, to improve function, and/or to allow a person to have a more normal appearance. Abnormal structures of the body that are corrected during reconstructive surgery may be the result of birth defects, developmental abnormalities, trauma or injury, infection, tumors, or disease. http://www.answers.com/topic/reconstructive-surgery I understand how insurances work. They are "for profit" businesses, that often make decisions based on profit/loss margins and weigh the probability of what decisions will cost them in the long run. I also understand that prerequisites are determined to be a measure of how conditions are handled, inured, and treated, but after looking at a case that shows clear evidence of problems, and having a way to alleviate them, and to deny, is a total lack of compassion and empathy. I implore you to rediscover the nature of the health service industry; to improve the lives of the people who use, pay for, and depend on these services. In an effort to not be totally redundant, I am sending you copies of everything I have submitted to the insurance companies, and their responses. I pray you review the letters and evidence, and overturn what is an unjust and truly insensitive decision, basely solely on numbers. As an independent mediator, please look at my health and suffering, and documentation of such, and grant my request for approval for reconstructive surgery, that will ultimately allow me to have a greater quality of life, and a true opportunity to be both healthy and normal. I thank you in advance for your time, consideration, and prompt response regarding my concern.