Yes, I have United Health Pacificare. I was denied twice, appealed, and denied again. I had documenation from my medical doctor indicating 6 months of re-occuring problems, a letter from my doctor indicating that a tummy tuck was medically necessary, and that my haning pannus interferred with activities of daily living. (And stable weight for at least 6 months) My doctor and I looked at Pacificare's guidelines and provided everything listed. I was actally denied by the Medical Group itself. (United Health) I was tired of fighting and started saving. The appeal denial letter indicated that my documentation did not fully suffice the interference with daily activities part. I provided copies of prescriptions for rashes, photographs of my hanging pannus, etc. I'm very grateful that my weightloss surgery was covered in full, and cannot complain that plastics was not covered. It would have however, been nice if I'd known plastics would not have been covered prior to jumping through all the hoops.
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Tina
June 30, 2003
LAP/RNY Dr. Callery
Surgery Date 294
Tummy tuck January 30, 2009
Current 152
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