Question:
Help! Has anyone been denied by their insurance for a Panniculectomy?

I just got denied from my insurance company PEIA for a medically necessay Panniculectomy. Is that normal for the first time the Plastic surgeon request approval? If I should appeal I wonder if I would get denied again. Not sure at this point what to do. Any suggestions would be appreciated.    — Vickie H. (posted on March 27, 2002)

March 27, 2002
I was denied also because I had no back problems, rashes etc..... I had to go in the hospital for a hernia repair and I paid the surgeon $3,000 for the panniculectomy. If your having problems with rashes or backaches I would at least try and fight it. Good Luck
   — Helen C.

March 27, 2002
Find out exactly why they denied you. Have you gone to your PCP for any symptoms? They probably want documentation that it is medically necessary. It may just be that the surgeon didn't send in enough info. The first thing is to get the denial letter and see what it says so you can reply to that specifically.
   — garw

March 27, 2002
I was denied twice before mine was approved, but the reason for the denials was that they hadn't received all the information they said they needed. So, if you don't know WHY yours was denied, it may be as simple as that. It's sure worth it to try again & again (if necessary), but like a previous poster said, do try to find out the reason they denied your request. My fingers are crossed for you.
   — Kathy W.

March 27, 2002
I was denied on the grounds it was not medically necessary. Went through two appeals and finally appeared at a hearing, and the surgery was approved. You should definitely go through the entire appeals process.
   — kateseidel

March 28, 2002
I was initially denied by my primary provider, then was approved immediately after completing the appeals process. My plastic surgeon didn't seem surprised at all by the denial, and stated that it was fairly "standard" in his experience.....it's as if the insurance companies want to see just how badly you really want this surgery :-) Don't give up too easily. Both my primary and secondary providers ended up approving my panniculectomy and armlift (brachioplasty). Good luck!
   — Diana T.