cross post - need help with plastic surgery appeal

[Guest guest]

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, SPAINJuly 23, 1999 - self payOpen BPD/DSSee my pics: http://www.duodenalswitch.com/Patients/Kris/kris.html