FEELING REALLY DEFEATED

I AM FEELING A LITTLE DEFEATED RIGHT NOW.  I WAS DENIED PLASTIC SURGERY THOUGH MY INSURANCE. (although the doctor's office encouraged me to appeal it and said they would help).  IT TOOK THE WIND OUT OF ME.  MY BOYFRIEND DUMPED ME TOO WITH NO EXPLANATION (although the hanging skin on stomach and deflated breasts seem to be a turn off for him).  I KNOW I SHOULDN'T FEEL BAD ABOUT THAT BUT IT STILLS STINGS TO BE REJECTED, EVEN IF IT IS BY A JERK!

I will have to get a third job and save for the surgery.  I am getting very self conscience about my body and its messing with my head.  Anyway, just wanted to vent a little. 

If anyone has any suggestions for what to write in my appeal that has worked for you please help.

I don't have much hanging stomach skin but it does hang.  I have back problems, weak and separated stomach muscles for prior stomach surgeries also.  Already had back surgery so was hoping to get plastics on my stomach covered as medically necessary due to chronic back pain, etc. 

I don't have good enough credit to get it financed, so I would have to work three jobs cause I am already working two to survive now.  Kinda feels hopeless.  Any suggestions?

Val

Search "latest posts" under my name and you will find the text for an appeal letter for appealing a denial of reconstructive surgery under the California Health & Safety Code 1367.63.

Then have your surgeon read the DMHC decisions here wp.dmhc.ca.gov/imr/results.asp, and to notice how to phrase your request to get around the reasons for UPHOLDING the denials -- the insurance companies are getting wise to the law, and your surgeon will need to address these bases for denial in advance by saying how you meet their requirements.

Stop being self-conscious, and stop letting that jer****upy space in your head -- he's not paying rent.

Thank you so much DianaCox, I will have a look at this and see what can be done.  Thank you so much.

If the surgeon's office encouraged you to appeal, and offered to help you do it -- BELIEVE THEM.  Let them help you.

Boyfriend's an a-hole, though.

Hi. Dont feel hopeless. Denial is a part of what they do as a routine,a nd you still have options.  My suggestions:

1. Read the language of your plan and see what their criteria are for coverage

2. Consider getting a scan of your abdomen...prior surgery may have left a  hernia, which if present could help with coverage

3. If you have skin rashes, be sure they are documented 

4. Consider a residency trainng program for a lower-cost alternative.

5. Be sure your PS is on the ball in terms of submitting the data needed for approval...here's where reading your plan can help.


My website has a downloadable document called "Tips for getting insurance
approval" under PATIENT RESOURCES plus another article in the NeWeigh newsletter
you may find helpful:

http://www.drlomonaco.com/dev/plastic-surgery-patient-resour ces.shtml

Right click save as on the little icon to download the article or email us and we will send it to you.

Best wishes,

John LoMonaco, M.D., F.A.C.S.
Houston, Texas

www.DrLoMonaco.com
www.BodyLiftHouston.com

 

Thank you so much!!!! This is awesome advise.  I will get right on the appeal and do my homework.  Thanks a million, my spirts are lifted and I feel some hope.  Thanks again.

Val

DONT GIVE UP...that is what they are hoping for. Fighters get a good end result. You got some good advice here...follow it.

Charming is right...boyfriend is a loser. When the surgery is over and done and he comes sniffing around....tell him he has too small a....mind.  lol

Be well and keep on!!!

Soapy

Thank you Soaplady,  I am better now and working on plan B.  Thanks for the advise.  I will appeal and fight for what I want.  Thanks for all the encouragement....small mind, LOL  you got it.

Val

I was rejected at first but I found that the surgeon I was using didn't have the experience to submit for post bariatric surgery patients. I suggest you make sure the surgeon has experience with this for they can tell you what works with what insurance companies. I switched surgeons and the new one took pictures and got coverage in two weeks. I had requested an abdominoplasty and the insurance companies rarely cover these. They want to cover the panniculectomy. This was what actually got covered. But my surgeon will not do them for they are barbaric and he does Abdominoplasties as the default. What I did was get other procedures done and asked that the additional cost get wrapped into the cost for the uncovered procedures. He took that under consideration when quoting me so I walked out with getting the tummy tuck virtually free. He got business during an economic diffcult time. So, work with the physician to get around the system but try to get something covered from insurance. It's nice to have something with a stamp of "medically necessary" when getting these procedures for a leave from work and hospitalization costs. I also worte a letter and made sure my PCP followed up with a letter to reiterate the issues I had with breakdown and skin that was a concern with my physical activitiies.

Good luck.

Thank you Jadems,

I am trying to gather as much information as I can.  I don't have a hugh amount of stomach hang (how much did you have?) so getting a panni may not work out unless I can find some poison oak to rub on for the rash effects.  I will try everything, thank you.