Question:
Tummy Tuck Denied by UHC!!!!!!!?????

Hello everyone. I wanted to know if my doctor can appeal for a 3rd time? UHC has turned my down 2 times for my tummy tuck. The first time i had no documentation and the 2nd time i had documentation that i get rashes on my lower abdomen that is hanging over my pelvis, and they still denied me. Also, if i get turned down a 3rd time by UHC,or if my doctor doesn't feel he should resubmit a 3rd time, can i go to another PS and resubmitt my info? I know if i get turned down a 3rd time, i will be changing my insurance at open enrollment time. Has anyone had luck with plastic surgery through Cigna? If anyone has some advice for me please let me know what i can do. Thank you in advance for your answers.    — sexysag37 (posted on June 30, 2004)

June 30, 2004
Be sure your showing pictures of ALL of the excess skin (turn to the side grab the excess skin and pull it out as far as you can). Also, show pictures of the rashes. Pictures mean more then a thousand words. I would appeal the 3rd time and continue on. Eventually, you'll hit a peer review appeal which is just common people (not doctors) making a decision on your surgery. Let's face it, common people are more inclined to agree that you need the surgery because they don't see this amount of excess skin every day.
   — Patty H.

June 30, 2004
Fight girl fight. I would first ask for copies of what the PS submitted to the insurance company. Sometimes the plastic surgeons are reluctant to work with insurance company and thereby don't put forth as much effort as they should. I have to agree with the other posts that you should take pictures everytime you have a "itch" in that area. I originally had Kaiser insurance and had to change to another insurer. Once I changed insurance companies I got approval(for a full tummy tuck w/lipo) within three buis days. I sent in a letter as well.If you need any help please email me.
   — Michelle H.

June 30, 2004
Yes, you can appeal a third time, and if denied again, appeal once more to an Independent Review Board. Don't ever give up! There should be instructions sent with each denial on how to appeal to the next step. Good luck!
   — Leslie F.

July 1, 2004
I would keep on appealing, as long as you continue addressing the reason WHY they are denying benefits. What is the REASON for the denial? Address that directly. Good luck to you.
   — LMCLILLY

July 1, 2004
My friend in TX got denied for a TT from UHC, and she lost about 130 pounds I think. She definitely has a medical need as far as I'm concerned. Rashes, back pain, etc. I say appeal, and appeal again, and if you still get denied go ahead to another surgeon who might write a better precertification leter. I got a panniculectomy approved through BC first try. I don't know about Cigna. I heard they were pretty difficult to work with for the RNY, so I'd be checking it out before I committed to a year with them. Good luck, and keep trying. Sherry
   — sherry hedgecock

July 1, 2004
I was denied twice by Oxford in NY. I submitted a request for an external review to the NY State Insurance Board. My denial was overturned. I had lots of pictures, and letters from my PS, PCP, dermatologist and WLS surgeon. Call or look online to see if you can appeal to your state insurance board. My details are on my profile. Ann
   — Fixnmyself

July 13, 2004
I fought for over a year with UHC (useless health care). I had letters from my primary care doctor, chiropractor, plastic surgeon and orthopedic surgeon. I sent pics, my PS sent pics. Rashes were documents as well as back pain. I ended up paying for it. Irony: Doctor found a hernia when he went in. He repaired it without charging me (or the insurance company). Had he charged me after the fact, I would have went after UHC for some reimbursement. But... fight as long as you can. I went as far as my employer, but it was no longer worth the pain and mental strain it was causing me. I gave in and self paid. I only regret not doing it sooner.
   — missesrita