My insurance turned me down for my pannicolectomy

BeckyinTexas · 05-16-2008, 08:28 PM

I called my insurance carrier this afternoon and they told me that I wasn't approved because it was considered cosmetic. I don't think I've been this disappointed in a long, long time. I feel like someone just took a dream away. One that I wanted more than words can say. I pity the poor person that they would deem a medical necessity since I've lost nearly 300 pounds and was told by two doctors that I had 20-30 of skin that should be removed. What the heck does it take to be considered a medical necessity???? I'm still shell shocked because the plastic surgeon that I met with said he hadn't seen anyone that needed the surgery like I do. My question is this....has any appealed the decision their insurance company made? I'm hoping someone, anyone can help me because after I'm finished drying my tears and get over the huge disappoint, I want to kick it into high gear and appeal to the max. If anyone can help me out, please, please let me know what I can and should do. It might sound so silly to most people but I've never been this down. I just hope and pray that there's something that I can do to change their minds.

salsa1877 · 05-16-2008, 08:31 PM

I have not had experience with this, but I would certainly be appealing. I know that a lot of lap-banders get denied at first and have to appeal. I would think this would be the same thing. Good luck...DOn't give up...You have come too far to do that . you have seen the good, the bad and the ugly. Now it is time to roll up those sleeves and attack this appeal with as much fervor as you did with your weightloss.

Frangipani · 05-16-2008, 08:43 PM

Becky,

Sorry to hear about this, but I agree with Salsa. If you search through the board you will find threads where people discuss appeals to their insurance companies that were ultimately successful -- so it can and does happen. I wonder if your Dr. can help with the appeal as well.

Considering your situation, the insurance company seems to be taking an absurd position.

Good luck and keep us posted!!!

Foofy · 05-17-2008, 10:00 PM

I have always heard that insurance companies very often turn people down on the first try for all kinds of things. They count on the fact that the majority of people give up and go away. The ones who are persistent, armed with documentation and determination, are often approved on the second or third try.

Becky. you lost 300 pounds! Clearly you are persitent and determined. Put your shoulders back and get back in there. Work with your surgeon to come up with a game plan. DON'T give up. YOU CAN DO IT.

Froggi · 05-17-2008, 10:19 PM

I was told after I lose weight after being banded and I have a pouch of skin that goes over my groin area insurance would pay for it...

ChristyC · 05-17-2008, 11:50 PM

I am being banded Tues. and I already have a grade 3 pannus! I was told to lose 100 lbs then insurance would pay for PS. I just read about someone who had to threaten their insurance co with "Obesity Law" and it worked immediately. I am not sure what that is, but ask!! Something to make you laugh in the meantime: I was telling my 40 yr old neighbor about the lap band for his obese wife, and he said, "Does that mean if she lost lots of weight, she could get that origami thing on her body afterwards?" LMBO
Hey this is just a bump in the road, it will work for you, never fear!!
You have come a long way and doing an excellent job!!

ChristyC

Godshelp · 05-18-2008, 12:04 AM

Ditto! Don't give up. Keep your eye on the prize.

StephC · 05-18-2008, 01:00 PM

Becky we will keep praying for you - I would definitely appeal and appeal and appeal - you deserve this and its gonna happen for you.

juliegeraci · 05-19-2008, 11:16 AM

Hi Becky, my insurance didn't cover it either. I had to pay $11k out of pocket. I hope you can win an appeal. I definitely didn't lose 300 lbs. Way to go on the weight loss!

Sue Magoo · 05-19-2008, 05:37 PM

Becky:

I've heard of people having their panniculectomy's covered if they had issues with skin rashes, or lower back aches. If you have these, get them documented with your surgeon and/or primary care and submit that it is medically necessary because of this history of rashes and/or lower back pain.

Best wishes.

Sue

BeckyinTexas · 05-20-2008, 04:15 PM

Thank you all for the support and advice. I'm just about over the shock of being turned down and ready to give them the fight of their lives! I'm going to be such a pest that they'll approve me just to get me out of their hair! I'm definitely going to look into the "obesity law" and see what I can find out about that. Thanks again to all of y'all for always being there when needed. I'm feeling a little more optimistic about this happening eventually than I was Friday. I'm going to make it happen come hail or high water!

Fran · 05-23-2008, 08:18 PM

First of all let me congratulate you on your weight loss. Second, do you have a rash? If not make sure you create one and have the doctor mail the photos to the insurance group. Do not give up. I won my appeal on a self pay for the band. Be well.
Fran

BeckyinTexas · 05-25-2008, 05:54 AM

Right now I don't think I have ever been so discouraged in my life. I received a copy yesterday of what the plastic surgeon submitted to my insurance company along with the pictures that I had done the day of my visit. I look in the mirror and it makes me sick at what I see but until I saw the pictures of myself, it hit me like a ton of bricks...my body is disgusting! I've never seen anything that looks as horrible as my body does. I've been up all night alternating between crying and thinking why in heaven's name did I ever let myself get to the point where I literally look like Jabba the Hut from Star Wars. I'm not sharing all this with you to try and make someone feel sorry for me, I'm just at a point right now where I half wish I'd never even lost all this weight because I feel more like a failure now than I did nearly 300 pounds ago. I'm scared right now because I just feel like saying I want to give up. I don't want to go through the rest of my life feeling like this. I recently met a man that is wonderful and tells me that my body is not what he cares about but he hasn't seen me without my clothes on. I can't even begin to think I could start an kind of relationship with him and not know that he'd be disgusted with how gross my body looks. I'm sitting here typing all this and I'm really not looking for sympathy, I just had to tell someone how I'm feeling and I know I'm telling people that can so relate to what I'm feeling right now. I honestly can't believe any so called doctor could look at the pictures that I looked at and say it isn't a medical necessity. They even sent pictures of me holding up my grotesque stomach so the open sores could be seen. I can't even begin to imagine what the hell does a medical necessity case look like if the poor person looks worse than I do. I'm sorry that I'm just rambling on and on about this but I'm really scared right now about how I'm feeling and I have to have someone to talk to that understands. I tried to talk to my sister last night but she doesn't understand at all. She told me to just be happy that I've lost so much weight and I'm healthier. I know that's true and I should just be thankful that the scales show a much smaller number but in my heart I know my body looks worse now than before. Again, I'm sorry that this is so long and I sound like a big cry baby but I'm honestly afraid about how I'm feeling right now. I literally don't know what to do but try and put my feelings down in here. I know before when I would get discouraged, this site and all the wonderful people on here have made me feel better and get over whatever was upsetting or concerning me but this is something different. There's no one else I can talk to besides y'all that even come close to understanding. Thank you all for letting me hopefully get some of this out of my system. I've got to snap out of how I'm feeling but after seeing the photos of myself, I think reality slapped me in the face. I'm really sorry to be such a mess right now but I just didn't know what else I could do but try and share what's going on inside my mind. If you've read this far, I'm really sorry for sounding so negative and I so don't want to be. I've tried so hard and it's not easy but now I feel like all my work has been for nothing. God, I'm even depressing myself more after rereading this but I feel like I HAVE to try and get this out of mind before I really start to lose it. I keep saying I'm sorry for asking anyone to read this, but I'm just hoping and praying that this feeling will pass soon! I wish to God I'd never seen the photos of myself because I think I actually had myself fooled into thinking I looked so good. The thought that keeps running through my head is why in the world did I ever let myself get to nearly 500 pounds? Thanks for letting me share this and I just pray that how I'm feeling right now passes soon because I hate feeling and thinking like this.

Sue Magoo · 05-25-2008, 07:47 AM

Becky:

Please don't let that insurance company or those pictures take your spirit away. If it doesn't get approved for insurance you just have to keep fighting and get a second job so that you can save enough to have the surgery done. I can totally relate to your pain and anger with yourself for letting the weight get so out of hand. But, it's better to put that in the past and move forward to the new Becky. Use that anger to drive you to solving this plastic surgery problem.

Take care, and big hugs!

Sue

salsa1877 · 05-25-2008, 08:08 AM

Becky..Just keep fighting it. I know right now this is tough and I feel for you. I have not lost nearly the amount of weight that you have and my body disgusts me as well. You just have to appeal the hell out of this. As someone mentioned before, they often deny on the first round and then will approve on appeals. Most people will go away after the first denial...but we know you are a fighter. NO one can lose 300 pounds and dnot be a fighter!

Have you talked to your surgeon about the appeal? Is there anyway that you could get this financed if your insurance doesn't come through. I HATE spending money and yet in the last year I have dropped 17000$ (with a 24% interest rate) on my Lap Band and 10000$ on my TT, so I know the burden of HUGE medical bills every month, but I figure this is MY body for the rest of MY life...and I am worth it. If you are just getting a panni then is there anyway you could afford it?

Here are big hugs!

Karri

My insurance turned me down for my pannicolectomy

My insurance turned me down for my pannicolectomy

Fight!!! And some humor

Stay your course