plastic appeal letter
Hey all - hope everyone is havine a great SUNNY and HOT weekend here in bama. I recently went to a plastics consult for the 2nd time recoomended by my WLS doctor. Sadly again I was denied - if anyone has had the same happen and been able to appeal to get insurance approval for pannulectomy PLEASE, PLEASE, PLEASE help with your advice :-)
thanks to all
Greg
thanks to all
Greg
HI Greg,
I just had the pannulectomy and tt 11 days ago. I was blessed to have mine approved first time around so I don't know much about appealing but here are a few suggestions, some I'm sure you've already tried but posting them just in case you have not.
* Obtain a copy of your insurance company's MEDICAL POLICY for this particular surgery. If you call customer service they will most likely tell you either a) excluded surgery (no recourse here) or b) subject to medical necessity. If they advise B then they have a medical policy that outlines the exact criteria for coverage. Example...if post WLS must be 1 yr out, weight loss off at least 100 lbs, sought medical care for skin issues etc...
(fyi - many times your plastic surgeon will have a copy of your insurance medical policy if it is an insurance they deal with on a regular basis)
*Once you have obtained a copy of that review the criteria carefully. If you do not meet the criteria then your chances of having it covered are slim. If you do meet the criteria then you need to send them the documentation for each. Example - pictures of rashes, dates of Dr visit for treatment of rash, etc...
Hope that helps. I would all recommend you go to the plastic surgery forum and post there to see if anyone there can help.
I just had the pannulectomy and tt 11 days ago. I was blessed to have mine approved first time around so I don't know much about appealing but here are a few suggestions, some I'm sure you've already tried but posting them just in case you have not.
* Obtain a copy of your insurance company's MEDICAL POLICY for this particular surgery. If you call customer service they will most likely tell you either a) excluded surgery (no recourse here) or b) subject to medical necessity. If they advise B then they have a medical policy that outlines the exact criteria for coverage. Example...if post WLS must be 1 yr out, weight loss off at least 100 lbs, sought medical care for skin issues etc...
(fyi - many times your plastic surgeon will have a copy of your insurance medical policy if it is an insurance they deal with on a regular basis)
*Once you have obtained a copy of that review the criteria carefully. If you do not meet the criteria then your chances of having it covered are slim. If you do meet the criteria then you need to send them the documentation for each. Example - pictures of rashes, dates of Dr visit for treatment of rash, etc...
Hope that helps. I would all recommend you go to the plastic surgery forum and post there to see if anyone there can help.
Phyllis
HW 314, SW 287, PS Weight 198, CW 181
Panniculectomy/Anchor TT 06-10-09
7.4cc in 10cc band
HW 314, SW 287, PS Weight 198, CW 181
Panniculectomy/Anchor TT 06-10-09
7.4cc in 10cc band
I was turned down twice - so don't give up! It's all in the wording of the letter. I actually saw 3 different surgeons, and tho I paid for the office visits out of pocket, it was well worth it to get that approval letter. (One consult fee was $350! YIKES, always ask & find out what your ins company will cover - BCBS wouldn't pay the consult fee b/c they denied the surgery.)
Good luck!!
Good luck!!
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