OK What now

Dear Friends,

I have gone from upwards of 561 lbs to right around 330. I am about 20 months out. I have tons of extra skin. I talked to my WLS about who to see for some help with skin and he referred me to a plastic surgeon. He took quite a few pictures and said I needed to wait about two months to hear anything from insurance.

I am a guy and honestly will be just blunt. I could easily fill a c cup if not d. The insurance company says: I know they feel this is cosmetic, what do  you think I can say to them or send to them to get a positive outcome?

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We have received your request for coverage verification and authorization for the following services for the member referenced above. For the purposes of making utilization management determinations, Aetna utilizes nationally recognized guidelines and resources, such as Milliman Care guidelines and Centers for Medicare and Medicaid Services (CMS)guidelines, as well as internal Clinical Policy Bulletins (available on Aetna,s website at http://www.aetna.comlcpb/cpb_menu.html),

We have received a request to review the following:

Service Or procedure: EXCESSIVE SKIN & ADJACENT TISSUE TRANSFER oR REARRANGEMENT Date of Service: 09/16/2013

ln order to complete our review and make a coverage determination, additional information is required. Specifically, the following information is needed:

Rhytidectomy, Lipectomy , Excision, excessive skin and subcutaneous tissue (including lipectomy);abdomen, infraumbilical panniculectomy, thigh, leg, hip, buttock, arm, forearm or hand, submental fat pad or anything else that may appear to be cosmetic:

Documentation of functional impairment that cannot be improved without surgery. photos can be emailed to [email protected] Please fax to Aetna precert Dept @ g59-455-g:650

This information is requested for the following reason:

The information is required to determine if the patient's condition and requested service meet criteria oulined in Aetna's Clinical Policy Bulletin.

We Protect Your Privacy:

Protecting the privacy of member health information is a top priority at Aetna. vy'hen contacting us about this Notice or for help with other questions, please be prepared to provide the member,s name, member lD number, and date of birth.

Please forward the requested information, along with a copy of this letter, within 45 days of the date of this letter to the following address or fax number:

Aetna
PO. Box 14079 Lexington, lN 40512-2079

 

 

Document, document, document!  Take photos of every red spot, sore and go to the doctors for every little problem you have related to the excess skin.  If you have back issues and or anything else.  You will be creating a history of "medical" issues with the skin not that you just want to look good in a speedo.  

Good luck and don't give up  

OK just so it's clear to anyone else. Some how this posted under my wife's account on Obesity help. Same question but dispite the "appearace" that my wife made this question, it was actualy me that posted it.

 

Are you confused? Just understand it should have said NG5Y posted the question (ME) not Melanie my wife...

Computers, got to love them.

 

 

Ditto what previous poster posted.
Document with GP/skin doc all sores rashes that are caused by excess hanging skin and chafing and various creams and powders prescribed that work and don't work after a short time.
You deserve this and advocate for yourself if need be.
You may still need to lose more weight but WOW on what you have already lost! And if this excess skin is removed your mobility will increase for your daily life -hygiene and getting around.
I am in awe of what you have done so far.
Mikimi in Israel