Anthem Denied Surgery - Advice Needed

I have lost almost 300 pounds & my plastic surgeon has requested (twice) to do the thigh surgery (actually will need 2 - the first to remove the excess weight, second to contour).  The second request we had letters from my primary physician, the Dr. I see for bariatric follow-up & I did a letter discussing all my issues.  The Drs. letters discussed rashes, pain, numbness & even physical therapist stating my excess weight was causing loss of balance.  Yesterday Anthem told me they denied it because my excess skin was a cosmetic issue only, nothing medical.  At the time I was too upset to discuss, but now I wonder -- how can they just ignore 2 letters from Drs. stating there are medical issues?

No matter what I will have the surgeries.  BUT, should I fight even more?  They say I can't appeal,, but the Dr. can ask for another review IF additional information is provided.  Should I go to another surgeon?  I've been fighting this battle for 10 months & am not sure how much more I should fight.  I need my stomach done, which will be my 3rd surgery & cannot imagine delaying that more than a year.  I'm just at a loss as to which way to go.

Any thoughts/ideas/help you can provfide would be deeply appreciated.  Thank you.

I've been posting here for over two years and I haven't heard of anyone who has had thighs covered by insurance.  I know of Breast Reductions, Tummy Tucks, Pannis and one of two cases of brachioplsty. 

Three hundred pounds is a lot of lose though so perhaps your case would merit another go-round with the insurance company.  Good luck and congratulations on your amazing WL success.

Hi.  I'd have to also say it's unusual to have the legs covered, although I have had several cases that were extreme that were accepted.  Why they will accept skin rashes and infection on the abdomen as more important than a rash/infection on the legs that interferes with walking I'll never know.

I had a patient who was a letter carrier here in hot, humid Houston who was denied our first try, but we convinced them that it interfered with her work (which it did.)

My problem is that many policies do not even have guidleines for arms and legs...its like those issues are not in their book.

What to do...
Can you get the language on your policy ? Does it exclude thighplasty ?
You will need to see about getting an independant review by a plastic surgeon which may help.
Have you had prescriptions x 3 months for the rashes/infections ?  That is a necessity too.

Some general tips on INS coverage under "Patient Resources" at www.drlomonaco.com/dev/