Question:
ADVISE ON APPEAL FOR TT

I HAVE HIP OF NEW YORK AND SUBMITTED FOR A TUMMY TUCK THROUGH MY PRIMARY CARE DOCTOR AND SURGEON THEY DENIED ME STATING IT WAS NOT MEDICALLY NECESSARY ANY ADVISE?? APPEAL LETTERS OR SUPPORT LETTER THANKS SO MUCH    — COLLEEN A. (posted on February 12, 2003)

February 12, 2003
most Ins deny the first time across the board...it may take something as simple as just stating that you apeal to make them LOOK at the info that was sent ...good luck
   — bekka K.

February 12, 2003
You need to get the reason WHY it wasn't considered medically necessary. Then with that info you can fight it. It just might be you don't have enough documentation.
   — ZZ S.

February 12, 2003
Hi Colleen. I have seen this subject come up several times, and it is an ongoing process with insurers. They want to know what medical problems the excess skin and fat are causing. Specifically, you may have dermatitis, candidiasis, or dermatophytosis...which are medical terms for skin infections or rashes caused by excessive wetness under the skin flap. The weight of the excess skin may cause back or hip pain and other problems...especially if you have any prior history of that. These are the things you need your doctor to exlain and document. They insurance companies have to sort out who may be trying to get a simple cosmetic case done, versus people who really need it...so this is how they draw the line. Some doctors are not interested in doing these cases, as they are quite challenging, require a lot of care during and after surgery, and the reimbursement may be quite low. So getting it done requires a little extra work and a motivated doctor and staff. Good Luck.
   — DrL