MDIPA / MAMSI

Has anyone out there had any experience with MDIPA in regard to coverage of panniculectomy?  I can see one on my horizon as the skin and rash issues are constant.  Thanks!   Lorraine

Hello Lorraine, I am employed with UHC/MA for member/provider services for the MAMSI health plans [MDIPA, Optimum Choice, MLH, and Onenet PPO].  Unfortunately the best option that you have is to call into our Member Services department (number on the back of your card) and request further information.  I highly recommend that you obtain a CPT code from your physician, as that is the easiest way to reference a covered surgery.  This will _most likely_ require prior authorization with the health plan, and may be a group specific exclusion.  The doctors (your PCP and surgeon) should work together to get all the necessary information to our Outpatient Resource department so that a timely decision can be rendered the first time.  It takes 2 business days for an authorization to be processed or updated for new information.