Philly / Del Val Info Help Request...
Hello All...I need your help...
Given the significance of location I'm hoping someone on this forum could help me out...
I had WLS-RNY back in Feb. 2005 (Dr. Meilhan, Temple Univ. Hosp. -Great Surgeon, but...drop me a line). Thankfully, I've had pretty good weight loss success but this excess skin around my waist is driving me nuts! I work out like crazy and eat pretty moderately but this skin/fat issue makes me look -and feel- like it's all for naught.
I've pursued PS a couple of times in the past. Prior to having my incisional hernia repaired (which admittedly -likely- arose from my own post-WLS insistence on getting back to some type of exercise -too soon?). I tried to push for a simultaneous/combo operation but Aetna denied the PS portion -twice. I did not appeal either time and I very much question how much effort was put forth by the surgeon's office.
So my requests:
Does anyone have any advice/strategies they can offer on the appeal process? (esp with Aetna -and yes I posted this request in the PS forum too)
[their denial reason was because the excess skin did not fall down to my pubic area]
Does anyone have a recommendation for a plastic surgeon -iN THE PHILLY -DEL VAL Region- who has been proactive in pursuing insurance -and getting insurance approval?
[I'll likely need a new consult to "restart" the process early 2009, so I'm very interested to doing so with a new surgeon]
I have explored the self-pay/financing option but that too poses its own challenges.
Please help!
japii
"...the true joy of life...being used up for a purpose recognized by yourself as a mighty one;
being a force of nature instead of a feverish, little clot of ailments and greivances,
complaining that the world will not devote itself to making you happy."
George Bernard Shaw
Aetna is very hard to get insurance approval.
the main criteria for the surgery is it must be MEDICALY NECESSARY, it must fall a certain amount around and almost cover the pubic area and you have to have rashes and they mus be documented for at least 6 months.. if you can't get insurance approval find a surgeon that will take credit cards , most do. I am getting abdominoplasty tomorrow along with another procedure and I am paying for it because it is not bad enough for insurance
Good Luck
japii
"...the true joy of life...being used up for a purpose recognized by yourself as a mighty one;
being a force of nature instead of a feverish, little clot of ailments and greivances,
complaining that the world will not devote itself to making you happy."
George Bernard Shaw
My plastic surgeon told me that if it came down to the last appeal to make an in person appeal and show them your problem.
Keep trying and get as much medical support as you possible can. Compose your own letters and have your PCP sign them. Rashes, back aches, depression etc can be considered medical necessity when "phrased" the proper way.
Good luck to you. I do hope you get an OK.
Jeanne
