Insurance denial!!

BonBon1
on 9/8/09 2:14 am - Somewhere, GA

I can't believe my insurance co.(BCBS FED) has denied my request for a panni! My dr. sent photos of my huge, hanging panni and then we followed up with info from two drs. about my constant rashes. And they denied me anyway!   I am very, very upset about this.
Does anyone have info about filing an appeal and what I should say in my letter? I've haven't gotten my formal letter of denial yet, but was told I had been denied over the phone today with the insurance co.   Any info at all would help as I have no idea what I should say at this point.
The darn thing about it is that my stomach is so much worse than so many photos  I see of people who have had tummy tucks. Even the dr. was sure I would be approved.
   I would appreciate any help but for now I'm just going to go have the blues for awhile.
                                                                   Bonnie

MelissaF
on 9/8/09 2:54 am - Northwood, IA

RNY on 12/04/06

Sorry to hear this sweetie...

First of all let me ask you a couple ?'s.

1) what was the basis of their denial? did they say?

2) Is a panni removal or any cosmetic surgery considered excluded in the plan? If so, it will be next to impossible to fight. Exclusions are tricky. You can try to use a lawyer to write a letter but even then they have basis for denial.

Get your policy out and review it and make sure all T's were crossed and all I's dotted and try to submit again.

Good luck!

Hugs, Melissa

http://www.onetruemedia.com/shared?p=6166c1bf498224d5a8b93e&skin_id=701&utm_source=otm&utm_medium=text_url

RNY- 12/04/06 with Dr. Matt Glasock
LBL - 4/28/09 with Dr. Rene Recinos

BonBon1
on 9/8/09 7:28 am - Somewhere, GA

RNY on 09/27/07

Thanks for the kind words, Melissa. I was told they denied me because the surgery was considered "not medically necessary".   DH and I read our policy closely before applying for the panni and both of us believed it would be covered. I was really surprised as I know they have paid for others to have the same surgery.
I won't give up, that's for sure!
                                             Bonnie

BigCityGirl
on 9/8/09 4:10 am - San Diego, CA

I've been hanging around this board for over two years now and lots of people get denied on the first application and then are approved on the appeal. Did they give you a reason for the denial?

Surgeon: Joseph Grzeskiewicz, M.D., F.A.C.S.
La Jolla Cosmetic Surgery Centre

BonBon1
on 9/8/09 7:31 am - Somewhere, GA

RNY on 09/27/07

City Girl, they said it wasn't "medically necessary".   I will definately appeal this and see where we go from here. One way or the other a tummy tuck is in my near future, I may just have to forget about getting an arm lift until later, though.
   Thanks for your input!
                                            Bonnie

B.J.
on 9/8/09 10:36 am - Rehoboth Beach, DE

RNY on 06/29/04

send me your private email and I will email you from work tomorrow -- I have a really good "medically necessary"link about lower back pain, rashs, etc.

-BJ

cutegirlshawn
on 9/9/09 10:33 pm - Albany, GA

DS on 11/17/09

Can I get that link also my e-mail is [email protected]. Thanks.

Kathleen T.
on 9/10/09 2:58 pm

RNY on 07/02/07

Me to please, I've been have back pains to the point of laying down on the floor with my knees on a chair for as long as I can.
[email protected]

"A Man's heart plans his way, But the Lord directs his steps.
Proverb 16:9
May not be where I want to be but I glad to be where I'm at.
Working at getting the rest of the way.

12/10/2012 I'll be having LBL, BL/BA, thigh & arm lift, eyelid
Body by Dr. Sauceda booked to 12/9--12/22