UHC denial for pani

Thinking of filing an appeal. I haven't had to do this before so I have no idea where to begin. I thought about getting an attorney that takes care of healthcare coverage and benefits to handle for me. Please any ideas and help would be appreciated.

=(  Did they give a reason for denial?

The said it was cosmetic. My insurance pays for reconstructive surgery.

Ask your PCP, lapband surgeon and even a dermatologist if your insurance will cover an appt for letters of medical necessity and fax them in an appeal/grievance. Find the code for panniculectomy (reconstructive) and use that code when requesting approval and reconsideration.
Did your PS submit approval for you? Ask your PS for the original submission to add to your file. You are entitled to copies of everything in your file. It's possible, a different code was used, or the term reconstructive was not. Key important info in approvals. If I can help in any other way, feel free to ask anytime. Good luck!

My lapband and plastic surgeon both wrote letter of necessity. My PCP will be writing a letter of necessity for my to send with the approval. My lapband surgeon told me to also include a letter from myself explaining the effects this has on my life and the experiences. My PS will be assisting with the appeal process. I will double check on the codes and make sure reconstrcutive was used. Is there anything else I should check or include.

Thanks for your help.

I am assuming your PS took photos and submitted them with intitial request.  definitely look over the intial letters yourself. If your surgeons won't give them to you ask your insurance company for them. I am not saying they weren't done properly. Just make sure. :)

Yes they took photos and submitted them. I will definitely request them and look them over. Wow what if they were done incorrectly? What would be the correct way to handle that? My PCP has me going through physical therapy for lumbar sprain. He says it's from the panni. Should I have the physical therapist do a letter?

absolutely! Have the physical therapist submit a letter also stating specifically that therapy is hampered or even not a long term fix as long as the panni remains. It's not going anywhere. If it wasn't submitted correctly containing all relevant information, ask it be fixed and they resubmit for you. If they refuse, find a different PS.

Thank you so much for all your wonderful insight. It sure has help a great deal. I thought about requesting all the information my insurance company used to make the decision to look it over as well. They said I would have to request it in writing but can have a copy. This may or may not be beneficial.

The after school specials said it best.."knowledge is power" =)