Denied

I didn’t get approved for my tummy tuck. I got the letter in the mail today. I’m crushed. I’ve cried so much that I have a horrible headache and my face is all swollen. Now I am just numb. I really wasn’t expecting this. My plastic surgeon was so sure that I would get approved that it didn't even occur to me that I wouldn't. I had it all planned out. The next step is to appeal which I will, but I’m not getting my hopes up. Any tips for an appeal?

For now I'm going to order the Kymora body shaper and pray/hope for my appeal.

Let me tell you something. My plastic surgeuron was sure i would be approved also and i was denied. but the doctor appealed and I was aprrove 3 weeks later. it was like the insurence didn't even look at the picture or calulate the bmi by the way the letter was stated. But I am approve and i was in shock. I am having a hernia repair and a tummy tuck on Aug 24th. It will happen. It will work out.  had open gastric by pass on oct 11 2007.  I will have an anchor cut for my tummy tuck.
  It will work out for you!! have faith!!

What was the reason for the denial?  That will determine how you write your appeal.

red

Not medically necessary.

First thing you need to do is to get a copy of your policy and see how they define medical necessity.  Then you want to write a letter that shows how you fit their definition.  Generally speaking now is the time to send them records of all of your PCP, dermatologist records that document your rashes and other issues caused by the skin.  Many times the insurance companies want documentation that these are long standing issues that have been resistent to less invasive treatment.  You will also want to send them documentation of the prescription creams/antibiotics that you have taken.  I remember distinctly on one appeal I helped with, the reviewer stated that there was no proof that the skin was making the woman ill.  That is what you are trying to show them -- that the skin is making you ill.

While I am certainly no expert on this, if you would like to send me your letter to proof when  you get it written I will be happy to look it over.  

Do you have any example letters you  could send me? I have no idea what I am doing. My biggest problem has been major back pain and headaches. My chiropractor sent a letter to them detailing my back problems. I honestly do not have skin problems at this point, but I think that is because I am so diligent about keeping clean. I shower twice a day. Early on I was having problems with a rash deep down in my belly button, but after I discovered it I started keeping it really clean and it went away. I know I have a small hernia.

You really need to get a copy of your policy.  You need to know under what cir****tances they will approve.  It could be that for your company (policy) that back problems do not constitute medical necessity.  You need to get the hernia documented and probably included in the surgical plan.

It is hard to know what to tell you to address without the information from your plan.  Think of this way -- you are going to have to "back" into the definition.  Once you know what they are looking for you can then "fit" the definition.

Red

As usual, Red is correct.  I'll add that Insurance Companies are in business for profit.  If they can deny you, what you are entitled to, it's more money (and bonuses) for them.  Appeal. 

Thanks girls. I definitely will appeal, and I know I overreacted. I'm a drama queen! But it has been a rough past week full of lots of little disappointments. I'm just sick of being so ashamed and embarrassed of my body and wearing these darn hot uncomfortable girdles!

Make sure you ask for the medical criteria.  You may not meet it.  Mine will not pay unless you have lost 100 plus pounds. 

Bye the way - not all insurance companies are out to screw you.  Not all insurance companies are for profit insurance companies.