Taking em' to court!

 Yup, Blue Cross Medi-cal is refusing to pay for my TT so I'm taking them to court. I finally got my "court date" and it's a phone hearing on the 6th of august.  I finally get to beg someone to ACTUALLY look at whats going on!

I'm nervous though, i dont know if they'll go ahead and cover or not. I dont know how long it will take to get a decision.  I also am scared that they WILL approve me...everyone says the extended anchor cut hurts worse than RNY which scares me even though I know my docs are quick to get pain meds working properly at my hospital.  I'm scared of what I'll look like after... even with the hanging pannus and super flabby upper abdomen, I'm already down to a size M/10-12... I've ALWAYS been huge...and now that theres a good chance I'll be super tiny - it scares me. 

I dont like people staring at me for any reason - I know this is going to cause quite a ruckuss amongst family (all good though)... My pannus is at least 6'' thick if not more and hangs half way down to my knees. Mons area...insurance says that the pannus has to hang below the pubic bone yet I have to move the pannus and mons just to find the bone.  

I'm also horrified that they wont cover, that I'll be stuck with this pain and burden forever.  Theres no $$ to pay for plastic surgery even if it is neccessary, we just dont have $8k sitting around, we dont even get that much in one year. 

I fought Blue Cross, I went through all my appeals and even to the Attorney General and what I discovered is if you don't have the terminology from Blue Cross's approved list of codes and surgery's then all you are apealling is a surgery request that they don't cover.  I abandonded my original request that was sent by my plastic surgeon that was requesting "cosmetic" surgeries, and wrote one with my PCP that stated word for word including codes for the specific surgeries that I needed.  I was approved in just over a week, I was then refered to the plastic surgeon who has to submit approval again so they can get the correct pay codes and it was denied from them again.  So I had to call Blue Cross and give them the case numbers of the "approved" letter and the "denied" letter to work things out.  The Blue Cross RN was very helpful, she called the plasitc surgeon, they worked out the pay codes and my surgery is tomorrow.  I am getting a Panniculectomy and excision of skin at the chest.  My surgeon is actually performing a Panniculectomy with an anchor cut and the excision of skin at the chest is a breast reduction.  I am also approved for arms and thighs to be done in December.  All I know is make sure you read Blue Cross's area for what they cover, because if your surgeon is requesting cosmetic terminology I don't think you will win, I hope you do.  Good luck.

I agree with Joe here.
Also you want Reconstructive Surgery, not Cosmetic.
I hope you win. It will well be worth the fight!
Mikimi in Israel

 Thanks guys :). I know I need reconstructive and not cosmetic but with the form of blue cross I have, I don't have the cpt codes available to me and there are only certain doctors/surgeons they let us see.  In my court request I have stated what their patient handbook says as far as "medically necessary" and that I more than exceed their minimum requirements for the surgery. I also state that I don't know the proper code and in the interest of saving time as well as pain and suffering, that they issue and approve the proper cpt codes. Being as I'll be talking with a judge I hope I get an understanding one :( 

 My extended anchor cut TT did not hurt at all! It it weren't die my scars and very flat tummy I would never know I has major reconstructive surgery!