Question:
Help need plastics doctor that is good in VA & will fight for approval

I was denied a tummy tuck by my insurance. I have lost 127 pounds. I am going to switch to my husband's insurance. But I need a dr. that is going to fight for reconstructive surgery for me & fight for me despite a denial. I live in Yorktown, but willing to go to Va. Beach, Chesapeake, Norfolk and even Richmond, VA. Thanks for any info and support.    — soccer-cheermom (posted on September 25, 2004)

September 24, 2004
picking a 'good' ps is important .. how he/she does their work. NOT fighting for appeals. I saw more than one doctor in that area and NONE of them dealt with appeals.. It was 'up to you'. You can (I did twice) appeal and win.
   — star .

September 25, 2004
I don't think your issue of fighting for appeals is limited to Virginia or PS. Across the country, medical offices are telling patients it is up to them to appeal and get insurance to pay for claims. Even at my PCP's office there is a big sign that it is the patient's responsibility to cover expenses not paid by insurance and to deal with any appeals of any tests or procedures. Medical offices file insurance claims as a courtesy but they draw the line at investing in office personnel to fight insurance battles. My bariatric surgical group stopped fighting patient's insurance battles because it got to the point that they were spending more time fighting insurance companies than they were on anything else. At our support group meeting, the insurance coordinator said fighting insurance claims got to be too costly, and they either had to hire additional staff and charge patients more or leave appeals up to the patient. They chose the latter.
   — Shayna T.

September 26, 2004
First, are you done losing all the weight. Have you maintained a steady weight for 6 months? How long did you have your surgery? These questions will come up. First, before most insurance companys will even consider this surgery you must be at least 1 year to 18 months post-op and have maintained a steady weight for at these 4 to 6 months. If you are still losing they don't want to have to re-do the TT. There also has to be a medical reason for the surgery. Excess skin is NOT a medical reason. When doctors preform the bypass they don't tell you that skin removal surgery does not go hand and hand. The bypass surgery is to bring you back to a healthy person. Skin removal is to make you like a "Normal" person but is considered cosmetic not reconstruction surgery. Your surgeon and primary doctor should be documenting medical reasons for having the TT (rashes, etc.) I've been approved for a thigh and butt lift due to pain while sitting (excess skin on the backside) and pain w/ knees due to thigh skin. However, I have to pay for my arms because there is no medical reason to have this done. I'm also going to have to pay 4,000 extra for the extensive reconstructive surgery that the insurance will not cover. All total expense is 6,500 out of pocket. I know people who have had bypass and get very upset when insurance companys do not cover the skin removal. I try to explain to pre-op people so they know they may re refused by their insurance company and to start saving just in case. You are going to have to fight the insurance company. If you move to your husbands they may consider this a past condition and may not cover. I'm 18 months post-op, have lost 198 lbs and have maintain 136 - 140 for over 5 months. I wish you the best of luck with your quest!
   — Linda R.

September 27, 2004
Don't think so much of "fighting" the insurance company. Rather, READ the plan for yourself and see what they cover and what they exclude. Then play by their rules. And, as Shayna said, doctor's don't have the time or staff to do your appeal. I got my abdominoplasty covered on appeal after the letter from my PS got a denial. And I used the wording from my insurance plan to get it covered. If you want it bad enough, do the research and the work yourself!
   — koogy