Question:
Help! My arms are flapping and I've been denied

I've now lost 166lbs. Aetna has paid for me to have a tummy tuck, but they claim the arms and breast lift are cosmetic in nature. What do I need to prove that this is necessary and not cosmetic? Would a letter from me be enough, or does it need to be from my doctor? Any suggestions? Lucy    — Lucy B. (posted on October 30, 2001)

October 29, 2001
I would take pictures of all in question, have your PCP write a letter regarding the issue, and you write a letter as to why you believe it should not be considered cosmetic and send that in. GOOD LUCK!
   — [Anonymous]

October 30, 2001
Hi. I'm not that far in my journey yet, but my arms are already flapping at 110 lbs loss...so I think the brachioplasty is in my future as well. I have heard of people having it covered because they nicked the hanging skin when they shaved under their arms. I have also heard of people having trouble with their shoulders because of the hanging skin. If your PCP documents some of this....that may help you out. Good Luck and keep us updated:)
   — Nicole P.

October 30, 2001
Hi Lucy... Sharp Health Care won't even pay for the tummy tuck. I will be self-pay for a TT and brachioplasty on Nov. 1. Had to take out a home equity loan. If you find any way for the insurance to pay for implants and a thigh lift, please let me know!
   — Anne G.

October 30, 2001
Your insurer won't pay for brachioplasty unless you can prove extremen functional impairment....i.e. the hanging skin is so streme that it prevents you from wearing clothing and from activities of daily life. I only know of one person who got approved. Her arms were truly deformed after she lost 300lbs. She couldn't wear clothes and the excess skin and fat was so heavy that it was causing neck and back spasms. She also had trouble moving her arms in certain positions. I've known hundreds of folks in group and I never saw another with such an extreme and debilitating problem. That's what you would have to document....with pictures....to get approval. For the vast majority of us (myself included) batwing deformity is a cosmetic issue.
   — [Anonymous]