Coventry Summit denied Brachioplasty

[ssflbelle 829]

Yesterday I received notice that my Coventry Summit Medicare Advantage plan has denied the removal of the excess skin from my arms. I have lost over 280 pounds, have had infections in the fold area of the elbow, have CTS, Ulnar Nerve damage and a left frozen shoulder and must wear shirts larger than my body to accommodate the size of these arms. My Doctors and I are going to fight this and hope for the best. Others whom were approved what did you do that got the insurance company to say yes to this much needed surgery?

[FluffyChix 17,418]

I'm so sorry you were denied and so glad you and the docs are going to fight it! You deserve it and the extra skin is a health risk!! ((hugs))

[jess9395 5,450]

Does your policy spell out what is required for it to be covered? Or is it a specific exclusion?

Many policies exclude certain plastics no matter the condition. Others (like mine) spell out specifics... for example a number of inches or a number of grams and no matter any other complications if you don't meet the specifics won't cover it.

Getting a copy of your plan and its requirements will help you address them and hopefully get approved. I didn't meet my insurances specifics. So no matter the rashes/infections/mobility issues/clothing issues mine would not cover it. I paid out of pocket.

[Rainbow_Warrior 996]

3 hours ago, ssflbelle said:

Others whom were approved what did you do that got the insurance company to say yes to this much needed surgery?

I have read (in threads on this website) that it is very important for the referring doctor or surgeon TO WORD THE REFERRAL OR INSURANCE CLAIM APPROPRIATELY.

You might need expert help from a doctor/surgeon who has succeeded in making a case.

Mind you, the picture you supplied is very convincing evidence.