Should I dumb it down?

kipz303
on 5/15/12 7:52 am
 I have sort of an odd question about insurance.  

Okay, I was denied for an 15847 (abdominoplasty). I appealed and was denied on that too. Come to find out they just dont cover abdominoplasty at all- ever- for anyone.  I can however, do a 2nd level appeal and ask that it be downgraded to a 15830 (panniculectomy), which I am going to do.  

I have written a letter to insurance stating my point of view - my husband is writting one as well as my mother (they both live with me so they are simply stating and backing up what I say about my life being hard with the extra skin).  

My question is this:  Should I dumb down my letter and formatting or should I do it normally and let them know inadvertantly that I'm well educated?  I've heard conflicting things on this where "playing dumb" is better but I wonder if they'd be more likely to approve if they figure "this chick knows her stuff we may not want to screw around on this one".  

Any opinions are welcome! (except the normal "cant you save and pay the extra", the answer is no)

 

RNY - August 13, 2010

LBL - October 29, 2012

 a total of 271 lbs lost!!

godzilla
on 5/15/12 4:26 pm - Israel
I'm not sure about dumbing it down but a couple of weeks ago a guy (also on DS) wrote on here his battle with his insurance and how after I think a year, he won but only after checking out what IS approved in his insurance plan.
Can you take what you can and pay the difference to what you really want and need?
I live in Israel. I was denied but appealed and won although I've already had Plastics and my upcoming Plastics is for boob lift and I need a scar revision and have inguinal hernia.
I hope I have helped you and not confused you.
Mikimi in Israel
kipz303
on 5/15/12 5:20 pm
 Oh Mikimi you're so sweet - you never confuse me! Sometimes I read between the lines to understand what you say but in the end I always get it!  I grew up next door to a family that spoke nothing but spanish but they were my best friends in the whole world!  Language is only one way of communicating =) 

As for what I really want and need...I don't have the money for a full TT even for the extra cut - I'm lucky to afford vitamins to be honest.  BUT I literally just want the hanging mass removed - I don't care much about looking perfect - I'm a modest woman and my husband asked me to marry him when I was 435 lbs, if he's happy then I'm happy!  The doc I chose includes a mons lift in with the panniculectomy since it's right there and doesnt take hardly any extra time. THAT is the main part I need taken care of is the pannus (hanging tummy) and the mons...i can't buy underwear in a store that my tummy doesnt hang out the bottom of..and trust me i've tried!!

As long as part of it is covered I'll get that done and then save for however many years i need to if my husband desires more done - I just need the stress off my back and the heat filled skin to go away lol

 

RNY - August 13, 2010

LBL - October 29, 2012

 a total of 271 lbs lost!!

godzilla
on 5/15/12 5:31 pm - Israel
I had the Panni but when talking felt it is easier to say TT but I think my PS might have done me a real TT.
But as you I take what I can for freer as I live off of Disability and I so understand vitamins and money issues.
Go for what you can get abd you'll still have flat tummy to enjoy.
Mikimi
kipz303
on 5/17/12 4:53 pm
 I got a letter from my PS and they really want to try for the full TT - they said even take it to court because it is what i NEED medically because of the condition of my back.  They did say though that in my personal letter to include something along the lines of "if you can't approve a 15847(abdominoplasty) then I would like to request that you downgrade to a 15830 (panniculectomy)" He did state in his notes that a "major panniculectomy" technically can be done but there are cuts that need to be made that would term it as an abdominoplasty.  All in all if they get approval and he does "extra" work I'll just be billed if insurance sees the extra and refuses to pay. That part I'm okay with just cant do an up front kind of thing.  

Today my back is totally messed up too so I'm really feeling this extra skin =(

 

RNY - August 13, 2010

LBL - October 29, 2012

 a total of 271 lbs lost!!

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