Bariatric Fusion Complete Meal Replacement
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Appeal Letter for Plastic Surgery, Tummy Tuck, Panniculectomy

The following is a copy of the persuasively written appeal letter I wrote for coverage of my panniculectomy to my health insurance company.  It worked, and I was approved.  (Please understand, it was written for the sole purpose of getting approval, details are super-TMI and quite embellished.)

I never had the surgery due to other health issues that arose during the same time, but I hope to someday.



Dear Blue Cross Blue Shield,

I am writing to you to respectfully request a Level 1 reconsideration of my claim for Panniculectomy with Dr.

This surgery is reconstructive following massive weight loss per the American Society of Plastic Surgeons and the American Medical association.

Your insurance company gave me approval on my Roux-en-Y Gastric Bypass on April 5, 2004.

I am 5’3” tall and was over 320 lbs. at my highest weight and had a BMI of 56.7, which put me in the Super Morbidly Obese category.
(In the above photo - you can see that the majority of my fat was at my lower abdomen and hip level, thus leaving me with a massive amount of extra flesh.)

I am currently at a weight of 165 lbs.

Due to the excess skin, I suffer from anxiety, poor body image, depression, skin-eruptions, skin breakdowns, itchy rashes, oozing sores + chronic lower back pain.  I also have problems with daily living activities and ambulation in exercise and sexual activity due to my massive pannus.

Unfortunately during the rapid weight loss, having destroyed the elasticity of my skin with morbid obesity, I have been left with a large mass of skin hanging from hip bone to hip bone.

The reason I am requesting this a panniculectomy is to be able to move without constant pain from the tugging and pulling on my back and the constant skin irritations and unhygienic conditions caused by the overlapping, chafing skin.

I now suffer from chronic consistent rashes under my pannus area that are extremely painful and unhygienic. 

Your Medical Policy for Panniculectomy states that the "pannus hangs below the level of the pubis." 

My pannus hangs beyond my pubis and I have to lift it to fit my body until normal undergarments.

The pannus causes two areas of rub rash, at the belly button level, where my skin folds in on itself because it is now empty of fat, and at my pubic area, just at the hairline.  It turns red, itchy, scaly, and when infected, oozes a disgusting yellow gunk.  This discharge not only smells horrible it leaves a stain on my clothing as well. I have been self-medicating the area with Lotrimin, Tinactin, Gold Bond Powders, antibacterial soaps as well as many other home and over the counter remedies. To no avail.  The primary care physician had suggested the use of above products, none of which have alleviated my problem.

This hanging pannus causes a serious ambulation issue in the area of sexual relations.  While it pains me to write this out, it is the awful truth.  I have to HOLD my pannus up to provide for sexual intercourse.  That is not normal.  It has put a serious strain on my marriage - and I find myself unable to perform sexual activities without becoming anxiety ridden, and have found myself in tears over the pannus hanging over my mons and interfering with a normal daily living activity. 

Not being able to have a normal sexual relationship has triggered a whole new  series of body image, anxiety and depression issues.  I find myself longing, "to be normal, at least for one day" without this giant "fat suit" that I was left with after losing the weight.

The mass of hanging skin from the pannus now makes me over compensate when I walk and puts extra stress on my lower back and legs. Exercising and walking can be an uncomfortable problem as the pull and tug of extra skin flapping with each movement.  In fact, I cannot jog in the way that I would if I didn't have 10-15 lbs. of excess flesh slapping me as I move.  If it were gone, I could exercise like a normal person and not be hurt or bothered by the pannus getting in the way of normal exercising ambulation.

I hope you will look into my case with a new sense of urgency as the problems that I have are a direct result of massive weight loss.



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