This is letter is to Blue Shield
from a person with a buffalo hump.
The letter from the Doctor is the
Ref #xxxxxx Proc Code 15876
for your phone message today explaining the refusal of benefits for my
surgery. I was very surprised that the photos and letter were not requested
by your office prior to the consideration.
is most definitely not cosmetic. If I were worried about looks I would
have had the surgery done years ago after the hump started forming in 1997,
and long before the discomfort and movement problems began. I have enclosed
a letter from my primary physician, Dr. XXXX, explaining the
need for the surgery. I am also enclosing photos taken by Dr. XXXX during
our first consultation. They are similar to the photos shown on CBS "60
on the January 21 program on AIDS.
I have chosen
Dr. YYYY to do the surgery. The primary reason is
YYYYY is the best doctor I know of in San Francisco to have performed
this method of ultrasound liposuction on the "buffalo hump" form of lipodystrophy.
I consulted with four surgeons and two additional doctors
(my nickel). Regular liposuction does not work, as the hump is very
One of the
surgeons, Dr. ZZZZZ, has performed surgery on "buffalo humps,"
however, his method is not recommended as it is very invasive, even though the
procedure (code 21556) is invariably covered by insurance. I would rather have
the best form of surgery than be guaranteed it be paid for.
problem with Dr. YYYYY is that many of his surgeries are indeed
cosmetic, and he has a very small office staff. For this reason, his office
misstated the need for the surgery, and his payment policies require payment up
front, with the patient dealing with the insurance companies.
reconsider this procedure. I think you will concur that it is medically
necessary. I have found in my 40 years of experience with Blue Cross and Blue Shield that you are usually fair.
To the insurance company from my primary physician:
is presently a patient under my care. He is being treated for HIV
infection and its accompanying symptoms. He is presently suffering from
sequelae of both the disease process and its'
standard treatment with anti-retroviral
agents. The main problem at this point is what we have termed lipodystrophy,
for him is an abnormal accumulation of fat in the dorsocervical
it is no longer a cosmetic issue but rather has reached sufficient proportions
the normal range of motion for his neck resulting in limited extension and a
forward flexion. The normal cervical vertebrae alignment has also been effected
the point he is now suffering from bilateral cervical nerve impingement with
paresthesias in both upper extremities.
It is now
medically necessary for Mr. AAAAAA to undergo surgery, preferably a form
of liposuction to limit surgical complications since he is immune-compromised,
correct this problem before the deficits he is now experiencing become
and irreversible. With your approval he will be referred to an appropriate