Question:
Does anyone know where to write, in case one gets denied for reconstructive surgery?

I am trying to have reconstructive surgery after my wls. My insurance does not cover plastic surgery after wls. I researched the cost of reconstructive surger(abs,thighs,arms,breasts)and forseeing me having to pay for all this sends chills up my spine! Any ideas?    — [Anonymous] (posted on January 25, 2002)

January 24, 2002
All insurance providers must provide a process in which to appeal any decisions which you feel may be unfair. Call your insurance company and request detailed instructions on the appropriate manner to file an appeal. You may simply have to submit lots of paperwork, or you may have to personally appear before an appeals committee to plead your case. I am 8 weeks post-op panniculectomy and brachioplasty (armlift). My primary provider initially denied my plastic surgeon's letter of medical necessity for "reconstructive" (NOT cosmetic!) surgery. He told me that he "expected" to receive the denial, that it was almost routine for insurance companies to deny this type of surgery initially. In my appeals process, the plastic surgeon re-submitted his letter of medical necessity, along with full frontal and side photographs....a picture, in this case, is TRULY worth a thousand words! In addition, I submitted letters of support from the surgeon who performed my RNY; my PCP; and a lengthy personal letter which outlined all the physical/emotional/psychological reasons that I felt this surgery was necessary for me to "complete" my WLS journey. Finally, I included a copy of the 1996 Position Paper from the American Society of Plastic Surgeons, entitled "Treatment of Skin Redundancy Following Massive Weight Loss". A copy of this paper can be obtained from http://www.plasticsurgery.org/profinfo/pospap/skin.htm. My surgery was approved within one week of the appeal. It is important to remember that arm and thigh lifts are rarely covered no matter what reasons are given during the appeal...I felt very lucky that the insurance paid for my armlift. Good luck, and I wish you the same success.
   — Diana T.

January 24, 2002
I agree with Diana. Most insurance companies are not going to cover it if it's cosmetic, and particularly with arms, there are rarely physical problems associated with the excess skin. If the skin does not cause a medical problem, then the surgery will not be considered reconstructive in their lexicon. In my case, I suffered from low back pain as a result of my pannus. My request for abdominoplasty went through two appeals letters, and finally an appeals hearing before they approved the abdominoplasty (denied the breast lift). It was necessary for me to "prove" the back pain, and my efforts to resolve it without surgery. -Kate-
   — kateseidel