Denied.... advice on appeal process

Hello all, I don't post often but check in daily and I'm hoping some who have gone thru the appeal process are willing to share your experience and provide some guidance.

A little background.... I had RNY in Dec. 2014 (Starting weight 386, surgery weight 344 and current 168.5) I've lost a total of 217 pounds from the beginning of my journey in August of 2014.  With a 217 pound weight loss there is some significant skin left over though my surgeon was surprised I did not have more excess skin and issues than I do .  My tummy and arms are the worst and my thighs are getting worse the last several months.  My breasts are severely deflated and have a ton of excess skin around the sides/under arm area.

My surgeon planned and submitted a two stage process, 1st lower body lift and arms and the 2nd thighs and breasts.  I was denied all surgery's (panni would be covered and possible breast reduction is covered with proper documentation of what these areas of excess skin prevent me from doing and what medical reasons there are for removal).  My insurance plan will cover a panni removal however even this was denied due to not having taken an oral medication for any issues caused by the skin (I have a script now..) and as I had not maintained a steady weight in the last 6 months (I'm still very SLOWLY loosing about 2 pounds a month though I believe that has come to a final end...)  The thighs, arms and lower body (buttock lift)  were denied as they are considered cosmetic surgery and my plan does not cover cosmetic surgery.  I can tell you though the removal of the skin on my arms is not cosmetic, I have significant arm/neck/top back pain after a day of working at my new desk.  I sit at a computer 8-10 hours a day and have been moved into a new desk about a month ago which is now "ergonomic" and my arms no longer rest on my desk as they had previously and this extra skin flops and waves all day while I'm typing and by end of day I'm sore and in pain.   

I'm working on my appeal letter and looking for any ideas/suggestions on things to include to encourage approval of the surgeries I desperately need in order to move on and be able to have a normal happy life as this excess skin as many of you all know weighs me down mentally and physically.

Thank you for reading and I hope some of you will share your experience and provide guidance and I go thru this journey.

 

Some people get the panni covered, but not many.  I do not know of anyone who got the arm lift covered.  Your surgeon's office may have some ideas.  Give it another try, but I would start saving to cover the surgeries that ins won't cover.  Just in case your appeal is denied.

Well-documented skin infections are a good reason.  and back aches from large breasts - the deflation per se is more of a cosmetic complaint.

Document all rashes in fat hanging crevices via pcp or dermatologist.
Your appeal,letter should not use the word cosmetic at all-but rather a return of your body to a sense of normalcy.
Breasts: back and shoulder pains and that the bra is cutting ibto your shoulders.
Mikimi,in Israel