I am on my final appeal. This will be my external review. I have been trying to write a personal letter with added documentation. Do I need to try to shorten it to one page? If so what do I take out? Any English teacher here that can help with grammar issues? Lol
Blue Cross/Blue Shield
Of Texas
Appeal Id No 529532425
To Whom It May Concern:
I am writing to you to respectfully request an IER (Individual Eligibility Review) and for my case to be reconsidered.
This surgery I am requesting is not cosmetic. It is reconstructive following a massive weight loss per American Society of Plastic Surgeons and the American Medical Association. Like breast cancer is a disease and reconstructive surgery is covered in the state of Oklahoma where I reside. I had the disease of obesity. Which has left my skin very abnormal. I do not have a normal life or appearance due to the massive amount of skin. It is unhealthy, unsanitary, and is a hindrance to my health and well-being.
After several years of trying to get approved with your insurance company for Gastric Surgery I was finally approved in 2014.
I am 5’7 and weighed over 300lbs. I had a BMI of 52 which put me in the Super Morbidly Obese category. I have enclosed a before picture which you can see that the majority of my fat was in my abdominal and hip level, thus leaving me with a massive amount of extra flesh and skin. Above and below my belly button. I currently weigh 157lbs.
Due to the excessive amount of skin, I suffer from severe anxiety, poor body image, depression, skin-eruptions, skin breakdowns, itchy rashes, oozing sores, and chronic back pain. I also have problems with daily living activities and ambulation in exercise and sexual activity due to my massive pannus.
Unfortunately during my rapid weight loss, having destroyed the elasticity of my skin with morbid obesity, I have been left with a mass of skin hanging from hip to hip and below my pubis.
The reason I am requesting this abdominal or panniculectomy surgery 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 and chafing skin.
I now suffer from chronic rashes between the layers of skin at my waist and under my pannus, they are painful and unhygienic. There is nothing normal or hygienic about my skin. I have also included documents from my dermatologist and primary care physician where I have been seen for my skin problems.
One of the Medical requirements is that my skin hang below my pubis which mine does. I have to lift my skin in normal daily activities, like washing. I take 2 showers a day to try and keep my skin clean. I then use a hairdryer on cool air setting to dry my skin before using the Nystatin powder prescribed to me by my PCP to keep infection down. I also self-medicate with triple antibiotic ointment, Aquaphor ointment and powders with cornstarch, to no avail. My PCP Has suggested these products with little to no success. My skin folds rub together and always are several red and irritated. There is always a horrible embarrassing odor that I try to cover up the deodorant and sprays over the top of the skin. None of this is normal hygienic care. These are some of the extreme measure I take every day, just to try and keep the rashes under control. I carry baby powder, wipes, and ointment in my purse. To use on lunch breaks. Normal people do not have to do this. With summer coming the out breaks will increase to oozing crusty sores. Due to the heat and rubbing. There is no way to keep the skin up and dry. I have to pick it up and tuck it inside my underwear. I wear moderate to firm control underwear to try and help alleviate my back pain from it pulling and hanging. It does not work.
This is humiliating and embarrassing to even talk about this, but it has given me a whole new set of body image issues including anxiety and depression which has intern put a lot of stress on my marriage. The hanging pannus has caused serious ambulation issues in sexual relations area, physical and psychological. I have to hold my pannus up to provide sexual intercourse. It flops over my vagina. It hangs and makes slapping noises. I love my husband dearly but can’t stand the thought of holding up my skin, hearing the noises, or even see the amount of flopping, sagging, infected, smelly, and over all disgusting skin.
I still wear baggy clothes to hide the extra amounts of skin and are very apprehensive of people seeing me. This does not work well working for the public. I tell myself daily that there is a counter so people will not see the extra amounts of skin around my stomach. After all this hard work I have put in to making myself a normal healthy individual. I still am not. For just one day I long to see what it is like to be normal. To not spend extra time in the shower and bathroom moving, picking up, cleaning, and medicating this mass of skin I am left with.
The mass of skin has also left me with back and leg strain. I am in now in constant pain in my lower back from the pulling sagging skin. I have to compensate for my skin when I walk and thus puts extra stress on my lower back and legs. I am on my feet all day. So most likely I will have more medical issues with my back due to the extra skin. I also try to exercise but it is uncomfortable and difficult with the skin in the way and pulling and tugging on my back. I cannot jog very long due to the pulling and slapping against my legs. If the skin was removed I could exercise like a normal induvial and not be hurt or bothered by the amount of pannus getting in the way.
Please look into my case with a new sense of urgency to the health problems I have as a direct result of my massive weight loss and massive amount of pannus skin. I have enclosed extra medical documentation as said for my denial reason. I have PCP records, dermatologist, psychologist records, and more pictures showing before and after pictures, and some legion pictures.
Respectfully,
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