Question: I’ve lost the weight from my Cushing’s, but I have so much excess skin in my abdomen that I am very uncomfortable and depressed. Is there any way of getting the excess skin off other than surgery? What arguments can I use with my insurance company to have the skin removal classified as “medically necessary”?

Answer: The good news about this problem is the weight loss after successful treatment for Cushing’s; congratulations, not all successfully treated Cushing’s patients loose the amount of weight to result in excessive skin. The excessive skin can only be corrected by plastic surgery; no amount of exercise will get rid of the excessive skin. Several of my patients have experienced the same problem and achieved an excellent result from plastic surgery. Unfortunately, I was not successful in persuading insurance companies that the surgery was necessary because the condition was from Cushing’s disease (including sending a letter describing the problem and the medical records confirming the diagnosis and treatment). Thus, the patients were denied insurance coverage for the surgery and had to pay for the operation themselves. My suggestion is to have your doctor send a letter to the insurance company documenting your medical condition and stating that the excessive skin is a consequence of treatment for Cushing’s – and hope for the best.

Dr. Mary Lee Vance MD (Winter, 2008)