My insurance turned me down for my pannicolectomy

TexasBecky · 05-25-2008, 09:46 AM

Becky, I'm sorry you are having to go through this, but like everyone else is saying, you must not give up now. You've proven that you can overcome seemingly insurmountable odds. This too is something that you will be able to accomplish, one way or another. I hope your insurance will come around, but if not, I know you will find a way to make this happen. Have you looked into getting some legal aid? Explore all your options and try not to get discouraged.

erikadawn · 05-25-2008, 10:03 AM

ok thats good

Frangipani · 05-25-2008, 10:55 AM

Becky,

Big hugs to you, and I wholeheartedly agree with everyone else, please do not let this get you down.

I wouldn't be surprised if this insurance issue is simply the result of some incompetent person making a faulty judgment that will easily be reversed once this is re-submitted for approval.

It seems to me that with all of your detailed medical information, you have a very good shot at prevailing in this matter, so try not to get discouraged this early in the game -- this is just a temporary setback.

nip50 · 05-25-2008, 04:17 PM

Becky - Fight, Fight, & Fight! That's the only advice we can give you. Like other's have said, the insurance companies almost always deny it at first, but be persistent. My tt will be submitted within the next week or two and I expect it to be denied, but I plan on fighting tooth and nail to get it overturned. I can't imagine how they can say it's not medically necessary with all you've lost. You've done an outstanding job! Be proud of yourself and tell yourself you're worth the fight.

Now, I want to hear come Tuesday morning that you've filed an appeal, so work yourself up to it. Be strong! I already know you're tough (otherwise you wouldn't have lost all the weight). My prayers will be with you.

Knottafatty4ev · 05-25-2008, 04:30 PM

Beck - the doctor has to say that the pannus causes yeast infections and rashes and health issues. Sometimes you just have to be tough. If you are super-tough and super-diligent, and still unsuccessful with the insurance within 6 months or so, then there are finance companies you can go through. You just have to think of it as buying a new car - but this one will last forever. Also, if you're paying cash and really need it, any decent surgeon will cut you a break.

Fran · 05-28-2008, 08:54 PM

Do you have a rash? My insurance company would only pay if there was a rash and all other techniques failed-creams, lotions, etc. Have the surgeons' office take pictures of the rash and send a list of medicines you have tried. Complain to every doctor you see, and I mean EVERY that the excess skin is creating a rash, bladder problems, back problems, etc. Good luck, I will think of you. Just remember, you are an inspiration to all of us for the amount of weight you have lost. Be well.
Fran

BeckyinTexas · 05-29-2008, 10:16 AM

Thank you all so much for the suggestions and encouragement! I was so depressed this weekend and I felt totally helpless but since then, I'm getting back to my old fighting slef and UHC is going to get a run for their money! I made an appointment with a bariatric doctor so he can start documenting the problems that I'm having. All I have to do is lay off the Gold Bond powder for a day and the rash will be there with a vengance. Considering how hot and humid it gets here in Texas, the summer months probably will give me plenty of rashes to document. I also took someone's advice and contacting an attorney about the "obesity law" and what rights I might have under that. I haven't gotten any definitive answers from him yet, but I think he might be helpful with this. I had polio as a child and it affected my left leg and I've always walked with a limp. It's gotten worse now and one doctor said it most certainly could be from the weight of the extra skin but he failed to put that down on the letter he sent to UHC. That's something I'm going to bring to their attention. So, I'm in a much better frame of mind now that I'm trying to erase those pictures from my mind just as I plan to erase the results from my weight loss! Thanks again to everyone on here. All of y'all have never failed me even when I'm very discouraged. Y'all are the best!!!!!!

TexasBecky · 05-29-2008, 02:06 PM

Good for you Becky. I'm glad you have got your fighting spirit back. It is a shame that insurance companies are often so difficult to work with, but I really believe that this will all work out for you. Keep the faith and keep fighting!

Foofy · 05-29-2008, 03:20 PM

Think how empowered you'll feel when you win this thing!!!

legster · 05-31-2008, 04:32 AM

Becky, just FYI, I think the obesity law that was suggested is a website:
Obesity Law and Advocacy Center Check them out. I know they have helped many with bariatric insurance situations.

Legs

BeckyinTexas · 05-31-2008, 10:28 AM

Legster, thanks for the information and I'm going to try and see if they will help me. This might sound so silly and I should just be so thankful that I've lost so much weight, but until I get the surgery, I won't feel like I should. This has really taken me for a loop and I just have to get over it and stop worrying that they'll turn me down again. I just have to get it through my head, I'm going to have to fight them and hopefully Obesity Law Ctr. will help me out. Also, congratulations on your weight loss!!!!!

Fearless55 · 06-14-2008, 08:32 PM

When I met with the doctor he explain what it would take to get the insurance company to approve of the PS afterwards. Essentially it boils do to yeast infections in the folds of the skin. His term was "white mud"; they take a culture and submit that then the insurance company has little choice in the matter. I would revisit with your doctor or get a great case of yeast infection and proceed to your Primary Care Physican and let them help you fight the battle.

adgrad · 06-16-2008, 05:32 PM

Becky, first you are a Texan and Texans don't let people screw with them. Yes, yes, you're not a super model...even the super models have wacky body issues. But thanks to Photoshop and some great graphic designers, they always look good.

Next, time to stop letting the problem work you and you need to start working the problem. There's no such thing as being told no--you simply haven't asked them the right way, yet. Become a squeaky wheel. They want you to tuck your tail, look at yourself, have low self confidence and go away. That's the ticket to increasing shareholder value and revenue. The trick is not to let them make money on you.

So, you think you look horrible. I caught myself in the mirror and my legs were absolutely horrible, too. Do I set there and think, "Oh, I can't fix it?" No, I'm a damn Texan and we remember the Alamo and never give up.

Stop crying and feeling sorry for youself because that's what you are doing and set up goals. Maybe insurance does deny you but we're not talking about a ton of cash... about the price of a car or less. You can mow some lawns, sit some children, save some money, or whatever you do to reach your goal. Saving a mere $500 a month (or a simple $125) gets you to $5,000 and in two years you could have your procedure.

The question is how bad do you want it? America was built on hard work. If this is your American dream, make it happen.