Question:
What do I need to get the plastic surgery approval? Im 15 mos post op and almost at goal

REFERRAL/SURGERY RECOMM. LETTER. I'VE BEEN TO A PLASTIC SURGEON AND HE AGREES I NEED THE SURGERY, BUT I NEED MY PRIMARY DR TO WRITE THE LETTER TO THE INS. CO. PLEASE HELP ME WITH THIS LETTER OR ANY INFO TO HELP ME GET APPROVED/ANY APPEAL LETTERS WOULD BE HELPFUL ALSO. THANKS IN ADVANCE.    — LISA K. (posted on March 2, 2002)

March 2, 2002
My insurance company also requested a letter from my PCP she wrote on a prescription pad. Patient suffers from chronic dermatitis under panni and would benefit from a panniculetomy. Thats all she wrote also my surgeon wrote a letter and we sent graphic pictures of me holding it up with both hands a side view. It worked I had my surgery on 2-14. Good Luck.
   — susan V.

March 2, 2002
After my initial consultation with my plastic surgeon, he submitted a letter, as well as frontal and side view photographs, to my primary and secondary insurance providers. He warned me at the time to expect a denial, stating that it was almost routine for insurance providers to deny a panniculectomy or abdominoplasty on the first request. However, my secondary insurance approved immediately with no questions asked. My primary provider denied, forcing me into the appeals process (to which you are legally entitled). In the appeal, I submitted a packet of information which included another copy of the plastic surgeon's original letter, and letters of support from my PCP and bariatric surgeon which outlined the "medical problems" that influenced the need for this RECONSTRUCTIVE (not cosmetic) surgery.....chronic dermatitis (rashes) in the skin folds, diabetes which predisposed me to ongoing dermatitis and skin infections, chronic low back and joint pain which was aggravated by the heavy/hanging skin, and inability to comply with a prescribed exercise regimen due to the excess skin and limited range of motion. I also included my own personal letter in which I took the opportunity to thank them for paying for the RNY initially, listing all the reasons that the panniculectomy and armlift were important to me, and expressing my concern and amazement that a company that would be so cooperative in approving the WLS would now deny the additional surgery necessary to complete the journey and offer me a status of full health and emotional well-being. Lastly, 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". That paper can be obtained from www.plasticsurgery.org/profinfo/pospap/skin.htm My primary provider approved the surgery within one week of my appeal. I wish you the same good luck!
   — Diana T.