California post op reconstructive so called plastics procedures denied.-a remedy.

For those of you who have been denied by your California based HMO insurer for needed reconstructive surgery, especially with “Kaiser," but others as well, feel free to contact me directly via my OH profile- contact mailing and I will direct you to a firm in Los Angeles which is pursuing the matter with the substantive change noted a few years back in the CA Health and Safety Code found, and well researched by my friend and renowned, esteemed Attorney, D. Cox.

Put simply, this change in the law suggest a showing of the common “medical necessity requirements" for any number of reconstructive procedures applied for and latter denied may no longer apply and could now be remedied by a simple resultant showing of abnormal structures post-op and your need to seek appropriate remedies via their efforts pursuing the matter for a large number of so aggrieved individuals. This very well respected and high profile firm invited me to post this without making this expressly public in contacting them.

I’m a tad overwhelmed with work demands now. (Almost always these days,) but will make every effort to get back to all in a timely way.
 
Rock    

For much needed clarification for those interested, I'm adding in a posting by the aforementioned esteemed Attorney, D. Cox, from the main forum in reply to mine.

Her appreciated elucidation in her reply to mine reads as follows: 

" To follow up and elaborate on what Rock said - if
* you have EVER applied for and been denied coverage for reconstructive surgery to remove excess skin post-bariatric surgery
* by an insurance company in CA (especially Kaiser or other HMOs, but also a fully-funded PPO or POS plan),
* since July 1999,
* whether or not you ever followed up with an appeal,
* whether or not you ever self-paid for reconstructive surgery, and
* whether or not your are still currently insured by that insurance company,

this law firm may be able to help you get reimbursement for what should have been covered if your claim was improperly denied - especially if it was for lack of medical necessity.

If you are interested in this, send your email addy to Rock.  This will not only have to potential to help you, it could help others get access to coverage that is mandated by CA law more easily as well."

I trust it will prove helpful to interested parties.

Rock

Hi Rock can you please give me more info or direct me, I am to a Kaiser member , and had gastric bypass almost 7 years ago email [email protected]

thank you

You have mail.

Rock