draft letter to insurance - plastics?

jenniflorida
on 7/31/12 2:14 am - Washington, DC

I am asking if anyone has any documents or insurance letters you’re willing to share (identifying info blocked off) explaining the reasons behind plastic surgery for pre-clearance? I'm in the process investigating the options, and I have to contact my insurance and send them a letter. I do have some extra skin, but my main concern is I have lower back pain. I did not lose much weight in the hips, thighs, and buttocks compared to the rest of my body, and my job is sitting all day. So when I sit, my back is not straight, even when I try to sit upright. My back is always curved due to the extra weight in my buttocks. I think if I remove the extra I can sit upright and remove the discomfort and back pain. Part of this pain may also be the low hanging breasts as well. There are big bags of thighs on each side that I could remove. I have extra skin of the 2 arms, but these are not as important as hips, thighs, and buttocks. Please send here for everyone, or send me a private message if you have a draft or examples that I may use as a draft to start writing a letter to my insurance company. Thank you.

            
godzilla
on 7/31/12 3:04 am - Israel
Look for Joe C - he succeeded after three times and rewriting and he recently posted that he had his TT and chest and in December he will have other Plastics. I don't think his page is open to the public so if not then scroll back pages until you find him and send him a personal message.
Mikimi in Israel
jenniflorida
on 7/31/12 10:08 am - Washington, DC
Will do. Thanks for the lead. I am new to this forum.
Michele816
on 7/31/12 6:31 am
 I got approval from the insurance company for my tummy tuck back in January.  I have a letter that I sent with the initial request to the insurance company and it was approved in 3 days!  If you PM me with your e-mail address I will send you a copy of my letter.
        
      
ALABAMA
on 11/17/12 5:59 am - STONE MOUNTAIN, GA
Joe_C
on 7/31/12 11:21 am

I will have to get to my work to get the letter, maybe in a couple of days.  The biggest thing is to get the insurance policy for the requirements and surgeries that are covered.  I have Blue Cross, the have a policy call "excision of excess skin"  In this policy it states what types of problems the recognize (rashes, sores, interferance with ADL's )  For me I went to my PCP for about 6 months once a month and each time she had to change remedys for these areas of sores.  If you have back problems, keep records and comments from your doctors stating their thought for the back pain.  Also state in the letter the exact proceedures including the insurance codes that are stated in the policy.  The records of doctor visits and the exact surgeries to request are the key.  My letter got approved then when I was refered to the plastic surgeon by my PCP the plastic surgeon had to submit for payment, he had my letter but used their own terms and it got rejected.  I had to call the surgeon so he can resubmit with the correct terms with a letter of my own stating the case numbers of the approved letter and the rejected letter.  Then a couple days letter I talked to the insurance company to correct the request, they call the surgeons business office and worked out all the pay codes.  Got the call and scheduled.  I was approved and pay codes were submitted by the surgeon for a Panniculectomy and excision of excess skin at the chest.  The surgeon kept wanting to submit for a exteneded tummy tuck and adominalplasty and breast reduction.  On pre-surgery day I signed the order for a Panniculectomy and excision of excess skin at the chest.  My surgeon gave me a Fleur Di Li with adominolplasty and pretty much a breast reduction.  I feel very blest with my surgeon doing surgeries that provided the best results. 

   >>>Approved!!! Surgery 10-19-09<<<
              Starting an improved new me

        
jkjstars123
on 7/31/12 11:42 am, edited 7/30/12 11:43 pm - Tama, IA
I too would like to see the letter for some help writing a letter to my insurance. I too have Blue Cross. What is ADL's?

Thanks

  HW 304, SW 291, GW 160, CW 140 H-5'9.5"            

    

sumueulu
on 8/6/12 5:23 am
Activities of daily living...like cooking, cleaning, working, exercising.
Sarah
jkjstars123
on 7/31/12 11:41 am - Tama, IA
Today I was told by my insurance to submit a letter stating how all these rashes, sores and pain are causing me problems. I have been trying to get a breast reduction and lift covered by BCBS of Iowa. Been denied 3 times. Sent many pictures, letters from a surgeon and even a plastic surgeon supporting this. In Feb they finally approved for my panni and a hernia so I don't understand this. Neither does the two surgeons. They state I have one of the worst cases they have seen. My insurance does cover it but they are playing games. I'm a single mother of two and cannot afford to pay it out of my pocket.

Julie

  HW 304, SW 291, GW 160, CW 140 H-5'9.5"            

    

jennypooh9
on 8/8/12 9:20 am - NC
 BCBS il is playing games with me as well.  Any letters anyone wants to share would be greatly appreciated.  I have letters from pop, derm and wls and although they all support what BCBS is asking for they seem to need 1 or 2 more things.  So frustrating!
Thanks in advance for any help!
Jenny
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Jenny  
5' 2" HW 265
I consider this my re-birth!
       
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