Question:
Has anyone reversed a denial for excess skin removal that included documentation?

I was denied skin removal that has been well documented over the past year & half. Any advice is much appreciated as to how to proceed with an appeal. I also have an incisional hernia as well as degenerative disc disease of my back.    — Leslie T. (posted on September 18, 2004)

September 18, 2004
A well written letter from an orthopedic surgeon got me my approval. I nevr had any rash issues so technically I was out of luck. However, I have degenerative disc disease in 4 discs in the lumbar region. Even though I had the neurosurgeon write a letter I was denied. However, they indicated they would reevaluate it if I got better pictures (the PS's sucked) and an ortho eval and recommendation. It was like they were trying to tell me the way to get it approved. They not only approved it after getting the info they wanted, they approved it being done in 2 stages as the area above my belly button needed to be removed separately due to strange anatomy. <p>The other thing you need to look at is what exactly is their reason for denying and then address that. Usually it's that you do not meet one or more of the 4 criteria for medical necessity. Get the ortho eval and then sit down a write your own letter specifically addressing their reason for denial and why you feel you do meet this criteria. Don't give up without a fight.
   — zoedogcbr

September 19, 2004
I was denied twice, with some documentation and mild pictures from my PS. He called my insurance company and was told they wanted to see rashes which I did not have at the time of my visit to him. I documented my process for fighting my 2 denials on my profile. I eventually had to request an external appeal to the State of NY Insurance Dept. I would contact the insurance dept in your state and see if they have a procedure like that. At least give them a call and get their advice. Good luck!!
   — Fixnmyself