Question:
Help need plastics doctor that is good in VA & will fight for approval
I was denied a tummy tuck by my insurance. I have lost 127 pounds. I am going to switch to my husband's insurance. But I need a dr. that is going to fight for reconstructive surgery for me & fight for me despite a denial. I live in Yorktown, but willing to go to Va. Beach, Chesapeake, Norfolk and even Richmond, VA. Thanks for any info and support. — soccer-cheermom (posted on September 25, 2004)
September 24, 2004
picking a 'good' ps is important .. how he/she does their work. NOT
fighting for appeals. I saw more than one doctor in that area and NONE of
them dealt with appeals.. It was 'up to you'. You can (I did twice) appeal
and win.
— star .
September 25, 2004
I don't think your issue of fighting for appeals is limited to Virginia or
PS. Across the country, medical offices are telling patients it is up to
them to appeal and get insurance to pay for claims. Even at my PCP's office
there is a big sign that it is the patient's responsibility to cover
expenses not paid by insurance and to deal with any appeals of any tests or
procedures. Medical offices file insurance claims as a courtesy but they
draw the line at investing in office personnel to fight insurance battles.
My bariatric surgical group stopped fighting patient's insurance battles
because it got to the point that they were spending more time fighting
insurance companies than they were on anything else. At our support group
meeting, the insurance coordinator said fighting insurance claims got to be
too costly, and they either had to hire additional staff and charge
patients more or leave appeals up to the patient. They chose the latter.
— Shayna T.
September 26, 2004
First, are you done losing all the weight. Have you maintained a steady
weight for 6 months? How long did you have your surgery? These questions
will come up. First, before most insurance companys will even consider
this surgery you must be at least 1 year to 18 months post-op and have
maintained a steady weight for at these 4 to 6 months. If you are still
losing they don't want to have to re-do the TT. There also has to be a
medical reason for the surgery. Excess skin is NOT a medical reason. When
doctors preform the bypass they don't tell you that skin removal surgery
does not go hand and hand. The bypass surgery is to bring you back to a
healthy person. Skin removal is to make you like a "Normal"
person but is considered cosmetic not reconstruction surgery. Your surgeon
and primary doctor should be documenting medical reasons for having the TT
(rashes, etc.) I've been approved for a thigh and butt lift due to pain
while sitting (excess skin on the backside) and pain w/ knees due to thigh
skin. However, I have to pay for my arms because there is no medical
reason to have this done. I'm also going to have to pay 4,000 extra for
the extensive reconstructive surgery that the insurance will not cover.
All total expense is 6,500 out of pocket. I know people who have had
bypass and get very upset when insurance companys do not cover the skin
removal. I try to explain to pre-op people so they know they may re
refused by their insurance company and to start saving just in case. You
are going to have to fight the insurance company. If you move to your
husbands they may consider this a past condition and may not cover. I'm 18
months post-op, have lost 198 lbs and have maintain 136 - 140 for over 5
months. I wish you the best of luck with your quest!
— Linda R.
September 27, 2004
Don't think so much of "fighting" the insurance company. Rather,
READ the plan for yourself and see what they cover and what they exclude.
Then play by their rules. And, as Shayna said, doctor's don't have the time
or staff to do your appeal. I got my abdominoplasty covered on appeal after
the letter from my PS got a denial. And I used the wording from my
insurance plan to get it covered. If you want it bad enough, do the
research and the work yourself!
— koogy
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