Tummy tuck denied

My ins. turned down Drs. pre authorization for a tummy tuck! Said it was cosmetic; I have lost 100#, just had my 4th hernia surgery, last 2 emergency-this one kept me in the hospital 10 days and had to remove 3' of intestines because of gangrene....... could this be appealed and if so, how? would the dr. do it or would I? how would you approach the ins. co? any other ideas? Ins. is United Health Care

I would contact your insurance company and ask them to define for you what the difference is between cosmetic vs medical necessity. Get a policy bulletin if they have it. In other words, get the requirements in writing. Document every conversation with them. Who you spoke with, what time, and what the topics discussed were. Ask what the appeal process is. Keep your conversations as emotion-free as possible and work only with facts and statistical information but be friendly. Usually the difference between cosmetic and necessity is the amount of skin and if it's causing additional medical conditions and/or interfering with your ability to lead a normal lifestyle. My guess, and this is only a guess, is that your best chance for getting this overturned would be to get medical documentation that the excess skin is exacerbating the hernia and that the weight of the skin is causing the hernia(s) not to heal properly. The key to getting any insurance coverage for skin removal is documentation. Your own is a nice value-add but they care about the documentation from your medical providers. My advice to you is to ***** ***** ***** To any medical professional you see, whether it's a shrink, gyn, pcp, whomever. Anybody who keeps a medical record on you, complain about what the problems are and how they are caused by the skin. Frequent yeast infections or other genital issues go to the gyn. The extra skin is causing increased moisture which is causing xyz. If you're married, get it documented if it's physically interfering with your sex life. The shrink hears about the emotional toll. They all get told about the depression. Your pcp hears about the physical pains and non-gyn issues. Rashes. Sores. Anything and everything. They will prescribe creams or medications. Try them and then complain that they don't help. Show that you've exhausted non surgical means. And keep it all documented. Marybeth