Waiting on Appeal Decision for Brachioplasty.....Ugh....

[livvsmum 2,369]

So I was approved for my Tummy Tuck and panniculectomy in April of this year and had the surgery quickly after approval. At the same time they submitted for my brachioplasty, which was denied. I didn't stress too much because the TT was really my first priority, but while I was recovering from the TT I put together my appeal to send in to the insurance company, which ended up being 80 pages (lol....ooops). They received it on June 1 and told me I would have a decision via mail no later than 30 days later (which would be June 30). I am dying here. They are taking their good old time!!!

I guess that is what I get for submitting an 80-page appeal. Waiting is the worst! Now that I'm mostly healed from the TT I'm ready to get on with this and complete my plastics!

I don't know what I will do if they deny it again! I guess there is a 3rd level appeal you can do, but I don't what else I can provide them with.

We shall see I guess.,

[ShrinkingPeach 1,291]

Isn't insurance a pain in the butt? Sorry to hear you are having such a time with your approval. Hoping that the appeal goes through and you get your surgery.

[Djmohr 6,965]

I am really surprised insurance covers those procedures. I am going to have Brachioplasty, an abdominalplasty, breast lift and lower body lift.

From everything I have read, rarely does any of this get covered by insurance.usually you have to have infections to get even just a panini covered. I am still 35lbs from my goal and therefore a little ways away from being ready.

How were you able to get insurance coverage at all? Any advice?

[livvsmum 2,369]

I had recurring infections and skin breakdown on my stomach. I documented it WELL with my PCP for 4 months before even sending it to insurance. We sent it with a history of medications tried and failed, etc. and photos from the surgeon. It was approved in a matter of days and my surgery was maybe 1.5 weeks later. Quick and easy approval just like my sleeve surgery.

They did deny the brachioplasty, but what I've come to learn is that they didn't include any of the medical records when they sent it in for whatever reason. I am an avid runner and I am getting a lot of infections and skin breakdown from the excess arm skin. I have several months of PCP documentation , prescriptions tried and failed, etc, pictures, plus a very compelling letter from my PCP and a personal letter from me.

That's why all of that combined ended up being 80 pages for them to review. That's why I say if they deny it again, I just don't know what else there is for me to say to base it on, you know? I've thrown in the who shebang this time.......

[livvsmum 2,369]

I just called the insurance company because they told me they would have a decision on my arm skin-removal appeal by today. She said it was denied, but couldn't load the letter that was mailed out so she couldn't see any details other than that it was deemed cosmetic. I sent in an 80 page appeal full of medical records, letters from my pcp and surgeon, and a letter from me. I guess there's nothing else I can do. I will wait and see if the letter gives an option for a third-level appeal, because I will keep going. Kenny says he doesn't think I need it, but it really bothers me. Immmmma go cry now. For reals.

[sparksrn 65]

What insurance company?

[livvsmum 2,369]

highmark blue cross blue shield

[jess9395 5,450]

Dang! Good luck with your next level appeal!

My insurance said no way no how. I run like you but never got anything more than typical runner chafing so no "luck" there and my insurance has specific rules about how many inches your pannus must be past your groin which mine wasn't.

So I had to pay out of pocket. With all your infections and such I would hope you would have a different outcome. Keep us posted!

For what it's worth (not much) I think muscle/fascia repair from pregnancy (diasathis rectis?) should be covered for all women! And I bet if men got it it would be!

[livvsmum 2,369]

Dang! Good luck with your next level appeal!

My insurance said no way no how. I run like you but never got anything more than typical runner chafing so no "luck" there and my insurance has specific rules about how many inches your pannus must be past your groin which mine wasn't.

So I had to pay out of pocket. With all your infections and such I would hope you would have a different outcome. Keep us posted!

For what it's worth (not much) I think muscle/fascia repair from pregnancy (diasathis rectis?) should be covered for all women! And I bet if men got it it would be!

I was fortunate to have my abdominoplasty and panni fully covered. I guess I will just have to pay out of pocket for the arms. I think it will be much cheaper than the tt & panni, so that is a good thing.

[jess9395 5,450]

Dang! Good luck with your next level appeal!

My insurance said no way no how. I run like you but never got anything more than typical runner chafing so no "luck" there and my insurance has specific rules about how many inches your pannus must be past your groin which mine wasn't.

So I had to pay out of pocket. With all your infections and such I would hope you would have a different outcome. Keep us posted!

For what it's worth (not much) I think muscle/fascia repair from pregnancy (diasathis rectis?) should be covered for all women! And I bet if men got it it would be!

I was fortunate to have my abdominoplasty and panni fully covered. I guess I will just have to pay out of pocket for the arms. I think it will be much cheaper than the tt & panni, so that is a good thing.

Yes the brachioplasty is cheaper! There is that at least.