If they deny me - - they won't like me...

This is taken directly from the Anthem Blue Cross Medi-Cal Patient handbook...

"Reconstructive surgery" is done when there is a problem with a part of your body . This problem could be caused by a birth defect, DISEASE or injury . IT IS MEDICALLY NECESSARY TO MAKE THAT PART LOOK OR WORK BETTER.

Medically necessary or “medical necessity"
means reasonable and NECESSARY types of service to protect life; KEEP THE PATIENT FROM GETTING SERIOUSLY ILL OR DISABLED; OR REDUCE SEVERE PAIN through the diagnosis OR TREATMENT of disease, illness or injury.

******************
Just a little tid-bit. I plan on fighting if they deny me...its right there in their handbook.  Obesity is termed as a disease, is it not?  This extra skin gives me pain and is forcing my back into a pseudo-scolio curve which will end up permanently disabling me - my PCP even said so. A diagnosis wont get rid of or reduce severe pain but the TREATMENT, which is reconstructive...will!!  

Like i said, they wont like me if they refuse my plastics ^_^

There is a big difference between reconstructive surgery and cosmetic surgery.

They may pay for a panniculectomy but not a tummy tuck for example.

Make sure you know what they will cover and what they won't.
You may be able to pay an additional fee to get a better outcome.

I had my panniculectomy last Nov. and the insurance covered that as well as the mons lift. BUT they would not cover anything else. They deemed the TT as cosmetic and they won't pay for the skin removal for my arms - even though I get rashes in the folds of my arms. I wish you good luck in your fight. I wish Blue Cross of Texas paid for my arms but they won't and I can't stand the rashes anymore. Arm surgery is Monday morning.

Sharon

 All I'm sort of "demanding" is a panniculectomy - I'd love the full TT  which is what my doc tried for and they refused, I'm in appeal but I'm sure it will be either denied or downgraded to panniculectomy.  I seriously just want the flap of skin off and my mons lifted so I can buy underwear and not have the pannus fall out the bottom =(   I don't care about a "muffin top" or anything like that.  The P.S already said if he has to he will snip the belly button so he can pull down as much as he can. It will leave me without a belly button but I can save up and later on go pay for him to GIVE me a belly button if i so wish!  

I just want this 20 lb flap to be gone :(