Approved for abdominoplasty!

 So, the judge ruled that my insurance HAS to pay for my plastics in full!!! I am so happy it's stupid. 

Surgeon was out of office today but he will get my papers first thing Monday so I'll know more then! 

Yippee for you - and finally!
Mikimi in Israel

 That is AWESOME!!! Congratulaions!!!! ;-)

Congrats, good luck

Congrats!  I have been fighting insurance myself!  It can be tough!  Good job getting them to do whats right.

 Congrats!!! how exciting!  I was wondering, if you wouldnt mind sharing your situation around this? 
why you went to court, and what problems were you having. 
I would love to get my plastcs paid thru my ins too, I have providence

Well, I'll be uploading some new "before plastics" pics later today hopefully and I'll post a new topic for it so you can see the extent of the skin.  I have a horrible back due to being over 400 lbs by age 20. I also had major spine surgery when I was 22. That was what got my RNY covered. Then I dropped from 435 lbs to 175 in 18 months. This left tons of skin anit back pain. I went in to get the back pain checked out, had three MRIs and over the course of 2 months my scans showed that the way the skin pulls on my spine, I would end up with a "false scoliosis". 

 

So, I saw a chiropractor and he refused to work on me saying that the skin would just make it seem like nothing was being worked on, he referred me to having plastic surgery to remove it. 

 

First, I found the surgeons in my area that accept my insurance, then went with the one I found best. 

I submitted to insurance for coverage for an abdominoplasty,was Denied. 

I appealed the decision and was denied again, I had the option to have a dr. From my insurance board review the case, or I could take it to court. I chose court.

Even though I knew it would take longer I thought court was my best bet because I could explain in detail about my situation. 

It took four months for a court date and a littleover a month after my hearing to get a decision.  It was well worth the wait because the judge not only ruled that they have to cover an abdominoplasty but they have to cover whatever my surgeon deems (and can prove) medically necessary.

 

Now the key is to find the patient manual and look up the following:

What is their definition of "medically necessary" 

Exact wording on "reconstructive surgery" 

 

What helped me: obesity is considered a disease. My insurance tried to tell me thatbecause my condition was not caused by a disease, accident or birth defect that it couldn't be covered.... Well obesity is deemed a genetic issue as well as a disease...so Iused that in my argument to the judge.

 

I had NO rashesbecause I'm very OCD about body cleanliness and shower 2-3 times a day. So I simply stated how much I have to spend weekly on skin care products, water bill and electricity for the extra laundry and showers as well as pain AND suffering along with humiliation of dealing with "I can't go I have to shower"

I did NOT present any false information or try to twist things around. I didn't create any rashes or edit any photos to " look worse". 

My situation is different by far from most and getting a lower body lift with abdominoplasty covered by insurance is rare.