Question:
HELP!! with denial from BC/BS for arms

Denied today 10-10-03 for arm lift they said "COSMETIC" I advise I wanted the information for appeal letters to be sent. I need help as to the content of the letter I need to send. Any help will GREATLY appreciated. They covered my TT, I have lost 130 #'s please send any info or ideas.Lisa    — Lisa N. (posted on October 10, 2003)

October 10, 2003
Lisa, Save the paper and your stress. From what I've seen BCBS will NEVER pay for arms to be done as there is no functional problem associated with bat wings. It is strictly a visual or cosmetic thing. It would be more worth your time to start saving up instead. <p>Be glad they covered your TT as I just got my denial for an abdoninoplasty but they did leave the door open and say that when I'm at the weight I want to maintain that I should submit an orthopedic evaluation and recommendation and new pictures and they would reconsider. It almost sounds like they want to approve it but need to find a way to do it.
   — zoedogcbr

October 10, 2003
Hi Lisa! I am a pre-op, but from what I have read on previous postings, if you are having yeast infections, cysts, boils, razor burn, etc., those can prove to be medically necessary. If you have any of these things, take before pictures, go to your doctor and ask for a prescription for it and make sure the doctor documents for exactly what it is for. Use the meds, see if it help, if it does, take another "after" picture. Stop using the meds, go to your doctor and keep repeating the pattern and have your doctor keep documenting it. Also search the library, because I think that there are some examples of appeal letters for RECONSTRUCTIVE surgery for "batwings". Hope that this helps, good luck!
   — SherryWeber

October 10, 2003
I have federal BC/BS. I had a breast lift done with implants and they payed for the breast lift. How that got pass them I will never know, but am not going to look a gift horse in the mouth. They denied my abdominoplasty even though I had a hernia. I appealed twice and was denied. They paid for the hernia repair, so my hospital bill and everything was paid and I cut a deal with my wonderful plastic surgeon. Everything else, I'm not even going to try for.
   — Lisa N M.

October 11, 2003
I'm in Michigan and I've heard that if you have a lot of skin to be removed that U of M will do it for free, just to get the skin for burn victims. I would imagine any burn center might do the same. Good luck.
   — kkubinski99

October 11, 2003
Hi Lisa.....I've just gone through this with BC/BS of Michigan....in fact, I'm still in the middle of it. I had breast implants and brachioplasty (arm-lift) at the same time. BC/BS denied it as cosmetic. I appealed and they denied. I appealed again and they denied again. I went ahead and paid for it out of pocket and had my surgery done and afterwards a friend of mine said that there are insurance companies out there that will pay for it and as long as you don't have an exclusion in your policy for that particular procedure (which I don't), then FIGHT! So, I'm fighting. I appealed again (AFTER the surgery) and they said they couldn't appeal it because they'd never received a claim for it. Well of course not! Why would the hospital make a claim if it was denied in the first place? My denial letter stated that I could contact the auto workers national appeal people if I still wanted to appeal. I contacted the auto people and they are quite willing to try and get it approved, BUT.....before they can get involved, I have to have a claim submitted to BC/BS....BC/BS has to deny it.....I have to appeal their denial on the actual claim.....AND THEN the auto national appeals people will take it from there and see if they can get any of it approved. After talking to the national appeals unit, I called my surgeon's billing office and they put me in contact with the head of the billing department. I explained the situation to her and she said that the U of M has a contract with BC/BS and they have an agreement with them that if they collect money from a patient up-front, then they can not bill BC/BS.....so they sent me all my invoices and surgical reports and I filed the claim with BC/BS this week. Now I have to wait for them to deny it, appeal that denial, and then get the auto national appeals people involved. Do I expect any reimbursement from BC/BS on the $8,477 I paid? Who knows....it doesn't take too long to type up a letter and 37 cents for a few stamps, so it's worth playing the games if I have to! <p> <p>BTW, I had mine done at the UofM in Ann Arbor, and in regard to what the other poster said about burn units doing it for free if you donate the skin isn't necessarily so. I've heard that a few people have contacted them and they will only consider it if there's no stretch marks, blemishes of any kind, scars, etc. Good luck to you!
   — Lynette B.

October 12, 2003
I was told by my surgeon and primary doctor that they need to start recording on my visits problems I'm having with my extra flesh. Example: rashes, rubbing, etc. So when I'm ready to have the surgery it is already documented on my medical file.
   — Linda R.