Insurance Letter

This is letter is to Blue Shield from a person with a buffalo hump.

The letter from the Doctor is the second letter.

Federal Employee Program

Ref #xxxxxx Proc Code 15876

 Thank you 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. 

The surgery 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 Minutes" on the January 21 program on AIDS.

I have chosen Dr. YYYY to do the surgery. The primary reason is that Dr. 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 fibrous.

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.

The only 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.

Please 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.

Yours truly,



To the insurance company from my primary physician:

Mr. AAAAAAA 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, which for him is an abnormal accumulation of fat in the dorsocervical region. Unfortunately it is no longer a cosmetic issue but rather has reached sufficient proportions to alter
the normal range of motion for his neck resulting in limited extension and a forced forward flexion. The normal cervical vertebrae alignment has also been effected to 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, to correct this problem before the deficits he is now experiencing become permanent and irreversible. With your approval he will be referred to an appropriate surgeon. 



return to home page | contact us