Question:
is everyone usually denied the first time for reconstruction?

hi everyone im depressed and heart broken i have lost 165 pds in 10 months i have 3 hernias and other problems from excess skin , i submitted alot of documentation and pictures , letters from my pcp , and primary care doc, that i MEDICALLY needed reconstruction it was all submitted , and the quickly denied! cigna hmo in fl. i just wondered what i was in for ? do you thinki have hope? what has been your experience? please help any info or strories are welcome ty    — angela J. (posted on February 7, 2004)

February 7, 2004
That was my experience. My husband consoled me with the theory that everyone does get denied the first time because so many people will give up and they'll save a ton of money. I just sent my appeal with lots of supporting documentation and they approved quickly. Don't give up!
   — jen41766

February 7, 2004
My surgeon said the same as the previous poster. He said sometimes it can take a few appeals. Good luck
   — Fixnmyself

February 7, 2004
My plastic surgeon told me to automatically "expect" a denial initially. We were amazed that my secondary provider approved my tummy tuck and armlift immediately, with no questions asked. However, my primary provider denied the surgery, forcing me into the appeal process. Then, they approved the surgery within three days of receiving the appeal documentation....go figure! I think that it's true that insurance providers attempt to "weed out" alot of folks by making the process more difficult, and they assume that many people will simply think that appealing the denial is just not worth the effort. It's definitely worth it! My plastic surgery was the next best decision to having the WLS that I ever made in my life. Don't give up! Best wishes.
   — Diana T.

February 8, 2004
I was approved for TT and breast lift the first time. I worked 6 years doing this type of "physical enhancement" medical review and can tell you that it is up to the DR who reviews it. You can get one that approves everything, and one who approves nothing. FIGHT! APPEAL as many times as you can (with an appeal you need add'l info, ie: another DR like, MD, OB/GYN, Chiro etc..giving you a medical necessity letter) When it goes to appeal it automatically goes to a different doctor for review. Good Luck!
   — ZZ S.

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