This topic is about a person who has been living with an ileostomy since 2012 and has worked hard to lose 125 pounds on medical advice. The weight loss was intended to help with a large hernia, chronic pressure ulcers, and to improve the overall function of their ostomy. Their doctors recommended a surgery that would include hernia repair, stoma relocation, and the removal of excess abdominal skin to ensure long-term success. Unfortunately, their insurance company, Cigna, initially denied all parts of the surgery but later approved only the stoma relocation and hernia repair. After the surgery, the new stoma is recessed, causing issues with the ostomy pouch and skin. The excess skin remains, adding to the problems. The person is seeking advice on how to appeal the insurance denial for the skin-removal surgery.

Here are some helpful suggestions:

1. Ask your GI doctor and plastic surgeon to write letters of medical necessity to Cigna. These letters should explain:
- The chronic skin issues caused by the excess skin.
- How the recessed stoma and excess skin lead to appliance leaks and infection risks.
- Why previous non-surgical measures did not work.
Their professional input can be more persuasive than a personal appeal.

2. Get assistance from an ostomy nurse (WOCN) to document the issues with your appliance. Include photographs in your appeal to strengthen your case.

3. Consider legal support:
- Consult a lawyer, which can sometimes be done through free legal clinics or community services.
- Even a few letters from an attorney to the insurance company or hospital might encourage them to reconsider without needing to go to court.

4. While dealing with the insurance denial, try these appliance-management tips:
- For recessed stomas, Marlen Manufacturing offers deep convex pouches that might help improve the seal and reduce leaks.
- Use barrier build-ups by adding more material below and on the sides of the stoma to create a more even surface.
- Try different flange sizes, such as 3½-inch and 3¼-inch, to see what works best for you.

5. Keep detailed records of everything: denial letters, medical notes, photos of wounds, supply invoices, and any costs you’ve paid out of pocket. These documents can be crucial for both insurance appeals and any potential legal actions.