Question:
BCBSof IL. PPO denied my TT

I'm 1yr out this month and have hernia's that are really bothering me. My bypass sur. said for me to try to get a tummy tuck at the same time. I've been at the same weight since Dec. 04 and only 9lbs. away from my personal goal. So I went to plastic surgeon and he agreed to do a tuck and some lipo. Anyway today I was denied. Can anyone tell me what to do or email me on how to appeal (letter). I'm at a lost and very upset. I was overweight 20 yrs. so skin in abdom. hardly shrunk at all. Haven't had rashes yet but as weather gets warmer I probably will. I am having back, neck and shoulder pain also. Please help! Thanks in advance.    — lharrup (posted on April 22, 2005)

April 22, 2005
You need to work w/ your surgeon on this one. and make sure it is a surgeon who is good at working w/ insurance companies. They will likely pay for the hernia repair. BCBS paid for a panniculectomy for me, and I paid the difference. DID you have your PS send in pics of your pannus? they required mine to hang down over my pubic area. BCBSD would not approve with our photos in my case. Is the PS going to do the hernia repair also? If it is all at the same time he should be givingyou a good break on the out of pocket price. I would go back to them and ask how hey can help you. If they are not willing to go to bat for you startlooking elsewhere.
   — **willow**

April 23, 2005
I did not have to have any plastics done, but my co-worker who had WLS did. You need to document the results of having the excess skin, unfortunately, you need the rashes, and skin outbreaks to get approval, otherwise they look at it as being comestic. Since its summer get out your digital camera and start taking pictures of even the tinest pimple resulting from overlapping skin. GOOD LUCK and CONGRAT ON BEING A LOSER!!!
   — Anna M.