Question:
I need a tummy tuck, my insurance denied me. Does anybody have any info?

I had gastric bypass surgery a year ago and have lost 103lbs. I need a tummy tuck but my insurance has denied me. I can appeal that but how?    — Brandy S. (posted on January 5, 2003)

January 5, 2003
I had a adominalplasty (tuumy tuck) after I lost 100 pounds. I had to appeal it three times. i finally had it approved eith an external appeal. Make sure your doctor states that you have lower back pain and hygene problems from not being able to keep the area clean. Its really important that you find a good plastic surgeon thats willing to fight for you. The first one I went to told me that it was cosmetic and he would not bill my insurance, the second doctor said no way was it cosmetic and she helped me get it approved. I told the first doctor he was so mad he lost out. Good luck, Keep fighting them.
   — HOPE L.

January 5, 2003
Find a surgeon who feels you need reconstrutive surgey and not plastic surgey.
   — barbara A.

January 5, 2003
Every insurance provider has a process for appealing denials. Ask them to send you the paperwork outlining that process. You may have to appeal their original decision more than once, but it costs nothing and your persistence may pay off for you in the end. I had my tummy tuck and armlift last year. My plastic surgeon submitted his letter of medical necessity and photographs to the insurance providers. My secondary provider approved the surgery immediately, no questions asked. However, my primary provider denied the surgery, forcing me into the appeals process. Although some providers will ask that the individual appear in person for an appeals interview, my provider only requested a packet of "supporting medical documentation indicating the necessity of this reconstructive surgery". In the packet I included another copy of the plastic surgeon's original letter, as well as supporting letters from my PCP and bariatric surgeon. I also submitted my own personal letter outlining all the reasons that this surgery was important to me....physical, mental, emotional, etc... Finally, I enclosed a copy of the 1996 Position Paper from the American Society of Plastic Surgeons, entitled "Treatment of Skin Redundancy Following Massive Weight Loss". This can be obtained from www.plasticsurgery.org/profinfo/pospap/skin.htm. My primary provider approved the surgery one week after receipt of my appeal packet. Best wishes!
   — Diana T.

January 11, 2004
just appeal...I can fax you my appeal and all you need to do is change the dates. email me if you want the appeal letter. Good Luck and don't give up, Patience is a virtue.
   — walkerl35