Denied!

Hi ladies! 
I'm sure yall read this type of post often but it's my turn to whine.
I had wls 1-06. Highest weight was 450. I am now 180. At 1 year post op, I found out I had 2 small hernias. The past 2 months they have been bothering me so I went to a surgeon for the hernias then to a plastic surgeon that was willing to do an adiminoplasty and breast lift at the same time of the hernia repair. I was sooo excited.  They filed it to my insurance company and after waiting over a month, they called me on Monday and told me NO to all 3 procedures! Even the hernia repair!! Their reason for saying no was because all the procedures that I need are a result of gastric bypass surgery and they no longer cover gastric bypass surgery! I am so disappointed! The plastic surgery nurse called me today to apologize and to tell me to appeal.

I got the rejection letter in the mail today and I really want to appeal this!!!

Does anyone have any advise on appealing?? 

Thanks for listening!

Get in touch with DIana on the DS board, or Sarah on the Main Board-- both have tremendous experience. Appeal the crap outta this-- the hernia is rigoddamndiculous!

Thanks! 

I don't know anything about appealing but if I were you I would definately appeal. You have done a fantastic job on your weight loss and I pray you get approved for your plastics, keep us posted.  Debi

I sure will! Thanks a lot

I am sorry to hear your surgery has been denied.  I work for a plastic surgeon and a big part of my job is getting authorization for surgeries.  It seems to be getting harder and harder to get these types of surgeries approved.  I think part of the reason may be the current economic climate.  I honestly think the insurance companies are telling staff to really buckle down and deny as many as they can.  It is a shame so many deserving people are being turned down because of numbers.  I would really like to say to some of them, how would you feel if you had to walk around with all the redundant skin and tissue? 

I just hope things will get better.  But in the mean time appeal the decision.  Go to as many doctors as you can and send written letters to the insurance company defending why you need to have the procedures done (at least the panniculectomy), sending letters from the bariatric surgeon, a dermatologist and the plastic surgeon, you could even try a chiropractor if you are experiencing any type of back pain (and you are I am sure (hint, hint)). 

Good luck and don't give up the fight at the first hurdle, stay in it for the long run!!

Sandy

Thanks for all the info! 

Kay - you do not know me probably but you have always been a big source of inspriation for me on these boards.  You have come so far in your journey and I thank you for all your posts over the years. Keep fighting this.. insurance companies are getting so much more strict on their rules.  I have fought hard myself and finally won.. you can too.  The above poster who works for a PS gave great advice.. please keep trying, never give up the fight.  You are beautiful!

Melissa, I truly appreciate such kind words. It means a lot to me to know that people do follow my journey, read my journals and in some way I help them.

I am taking everyones advise and NOT giving up! 

Good luck in your journey

The hernia repair should be covered under all cir****tances irrespective of your policy. I'm not even sure why that would have been submitted for preauthorization, as that procedure is not normally one that requires preclearance with most plans. I've never seen a plan consider a incisional hernia from prior surgery to be considered a cosmetic sequala. Whoever reviewed that on their end likely misapplied your policy language in this instance.

Your policy very well may exclude post weight loss body contouring under all cir****tances & in that instance your appeal would be denied appropriately (fair or not). Review the policy guidelines on this. If it's explicitly excluded you may have to save for self pay surgery for your panniculaectomy and breast surgery.