Approved for abdominoplasty!

Hi Amos Family, I had my second level appeal yesterday and got the phone call today with an approval! Yippie.......I'm so happy. I have a date for July 6th but the office is working on getting me an earlier date Thanks Tooter for sharing your appeal letter with me I know it helped alot as i would have never have thought to put alot of the stuff into my letter on my own I also have my new before and after photos in the before and after gallery and on my profile Stephanie 235/126 -109 lbs gastric bypass 4/12/04 mammoplasty 3/23/05

Stephanie- How wonderful! Tell me - how did you go about the process of getting your information submitted to insurance? The surgeon I saw said she wouldn't even submit my case - that it wouldn't get approved. -Beth

Beth, I went to 3 ps. and then picked the one i liked best. we talked about a breast reduction and abdominaloplasty, he submitted all the paper work. i got approved for the breast reduction but denied the abdominaloplasty. so i went aheah and had the breast done. then i appealed the abdominaloplasty.and got denied again. I wasnt sure on what i needed so this time i called to appeal and the appeals nurse told me to read my reasonings for denial.........which was proof from dr. treating rashes(6 months worth) photos of rashes and hanging skin,and a personal letter( i think just so they get a feel you arent doing it for cosmetic reasons) and i reappealed on may 2nd got a call the 5th i think for a date for the 9th ..i couldnt do the 9th i still had to develop my photos and send them so we went with the 16th for th ehearing over the phone (as my ins co is in pa) it was my pcp whom is treating my rashes and myself and the medical panel of 7 ppl. i got the call the next day with an approval. I would say to you shop around for ps and have your rashes on record..and that you have been using home remedies like powder antibotic creams and support hose /panties and hen the dr will give you prescription strnght meds i had bactorban and lotrimin. and got lil or no relief. and thats what ins co want to see.........that you have been medicated and have recieved no relief............you need to find a ps taht will work with you............Good Luck to you...........Keep us posted on how you make out. Oh and for a dr to tell you you wont get approved how would they know all ins co are diffrent.....if you fight it to the end and can provide them with what they need then you will win..proving it medically ness is the game! Take Care Stephanie

Wow, congrats! Yes, PLEASE tell how you worked through the insurance! What insurance do you have? Reading your post gave me hope!!! Aimee

Aimee, Thank-you im so happy cant wait for it to get done....... I have bc/bs ppo of pa. You should have plenty of hope.just fight till the end and you will more then likley win...........just provide the ins co with all the info you gather......be sure to read your first denial letter very well under the reasons for denial and then turn around and appeal it with th einfo they didnt have the first time Good Luck to you Stephanie

AWESOME LADY! I am so hoping that I'm going to be approved. . . .*pray pray pray* This is GREAT to read. ~Lara

Lara, Im praying for you! did you already submit to the ins co? MY fingers are crossed that you get approved.........i have heard your more then likely have a better chance of getting approved for a pnniceloctomy over a abdominalplasty.......so i tried the abdominaloplasty first and if i got denied down to teh last try then i would have turned around and started one for a panni..........just wanted to save myself money.........my ps if only panni was covered would have charged me 1800.00 out of pocket to do the full abdominalplasty which i would want .i cant see just having below the belly button done i have a role of skin above my belly button and i want my muscles tightened. so it would be worth teh extra $ Good luck to you Stephanie

I went last Friday for Consultation and they only would file for the panni but then they called me and said that I had to be 18 months out to even file. I also have BC BS ppo but of Michigan. Will have to check out other plastic surgeons. But now I have some more hope on insurance paying. Thanks

Robin, Is the 18 months your ps requirements or ins? Just fight till the end..... if you submit for panni only ps usaully will do a full abdominaloplasty for an extra charge.........at least your not paying for the hospital,anesthia,ect...just the extra work being done.........if i was to get approved for the panni only my ps was going to charge 1800.00 for the full abdominaloplasty. Good luck to you If i can be any help to you just email me Stephanie

Congratulations!