Re: cross post - need help with plastic surgery appeal

[Guest guest]

I have emailed you privately. This may help.

> I have BC/BS of Michigan, Enhanced Plan with General Motors. I was

denied reconstructive surgery on my breasts and abdomen because it

was not 'medically necessary'. My surgeon and plastic surgeon both

wrote that it was medically necessary.

>

> Here is the thing.... GM has hired an outside company to determine

the medical necessity of surgeries. Their doctor spent less than 5

minutes with my file when he denied me. I have 2 docs saying it is

MN and he is saying no. Also, in GM's policy, it supposedly says

that if one has intestinal bypass surgery and has lost in excess of

100 lbs, then one would qualify for surgery. I asked for this info

in writing and they are denying me access to this information.

>

> I really need help. Any ideas?

>

> TIA,

>

> kris

> ~~~~~~~~~~~~~~~~~

> Aniceto Baltasar, MD

> Alcoy, SPAIN

> July 23, 1999 - self pay

> Open BPD/DS

> See my pics: http://www.duodenalswitch.com/Patients/Kris/kris.html