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Panniculectomy Insurance Denial


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Hi I'm actually new to this site but I had my gastric bypass 4/5/06 I'm having several issues with rashes under my belly and in my belly button and I just went to see a plastic surgeon for a possible panniculectomy and my insurance denied it and this is my first attempt though so I think I will appeal does anybody know any good ways to get my appeal approved any tips that I should use or could use and it research that I can do?

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19 hours ago, Gmaof3 said:

Hi I'm actually new to this site but I had my gastric bypass 4/5/06 I'm having several issues with rashes under my belly and in my belly button and I just went to see a plastic surgeon for a possible panniculectomy and my insurance denied it and this is my first attempt though so I think I will appeal does anybody know any good ways to get my appeal approved any tips that I should use or could use and it research that I can do?

I've heard the following helps - document your rashes with photos and dr visits. Does your insurance require that your belly hang down a specific length? If you don't know, find out. The woman who ran the offline support group I was in when I was newly post off had a panniculectomy covered by insurance and she suggested anyone who is interested to keep documenting and appealing. Good Luck!

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  • 2 years later...

My insurance just denied my request for a panniculectomy.  I am 4 years post op from having the gastric sleeve.  Does anyone have a successful letter they used to get an appeal approved?  I could really use some help!  

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8 hours ago, Karlaen said:

My insurance just denied my request for a panniculectomy.  I am 4 years post op from having the gastric sleeve.  Does anyone have a successful letter they used to get an appeal approved?  I could really use some help!  

From what I've read here on multiple occasions, you need to be able to show proof (via photos usually) of the rashes, skin breakdown etc. Not just a one off either, they generally need multiple times skin breakdown has occurred to show it is a persistent issue that the usual treatments can't control. They generally won't approve these surgeries without "medical necessity",  and that's a worldwide issue when it comes to abdominoplasty. In Australia (where I live), they are at least coming around to allowing psychological distress to be part of a medical necessity claim as long as your insurer covers this procedure....many exclude it from cover though.

 

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