HAP and plastic surgery

I have HAP insurance and am ready for plastics.  I am looking for any advice, help, experience with HAP.

I just had a tummy tuck in June, and I have HAP.  I did have to go through the appeal process, and it was not easy.  There must be dermatologist proof, and not just your PCP.  It was worth the battle.  E-mail me if you have any questions.   Carol

Hi Carol,   If you don;t mind, please share the process with me.  I was going to switch to BCBS for 2008, but we have a $2000 deductable and I would rather use that money else where.  Who did your tummy>  Are you pleased?  How long was the process to get approval?  Thanks

I do not mind at all.  My PCP gave me a referral to a plastic surgeon, who did her consult, and that is where the process has to begin.  She put in her request for abdominoplasty, knowing that it would get denied,  when we got the denial, 1st level, then I sent a letter from my PCP, records from the plastic surgeon, and my medical record supporting the skin breakdown secondary to the extra skin.  I was denied a second time, because my skin breakdown was not treated for 6 months by a dermatologist.  So I did second level appeal, where I sent another letter, and requested an in person appeal.  Two days before my in person appeal was suppose to happen, I received a call from my advocate that they reversed their decision  and that I was approved.    I had my consult in January, I received my first denial in February, I sent an appeal and received the second denial by the end of February, and did my second level appeal, and had a decision by March 17th.  The earliest that my surgeon could do my surgery was June 27th, so that was my date.  So it took about 2 months for the appeal process.  Do not let the process discourage you, you will win if you are persistant.  If you choose to go to BCBS, be careful, because they usually will see this as a pre-existing condition, and will not cover it at all, EVER.  So you might be better to stay with HAP and do the battle.  It did not cost me a penny.  Dr. Daniela Rodriguez did my surgery, and yes, I am very happy with the result.  If you get to that point, and you want my appeal letters, just let me know.  Good Luck.  Carol

Thank you so much Carol,  I may very well want your letters.  I'll let you know.  I hope to see my PCP this Friday to get referral to Dermatologist..  I seee my Plastic surgeon to get consult in about 1 month.  I have decided to stay with HAP and will fight the battle for approval.  thanks again Debi