what is it called???

What is the thing called that I need to ask the insurance company on what is needed for approval of plastics.  I know that it has a name, but I cannot for the life of me think of it. 

I want to call the insurance company and ask them to send me the requirements or qualifications of what it does take to present to the insurance company for approval or denial.  Like I said, I cannot remember what the technical term is for this paperwork.  I am starting to have problems lilke smell and rash and things of that nature, and I need to make sure that I have the doctor document all of what they require to try to get insurance approval.

I want to thank you all in advance and appreciate any and all help.

Thank you.

do you mean co-morbidities?

I'm not sure of what term you are looking for, but you can just ask them what the criteria is that you have to meet to be considered for (a pannectomy, or breat reduction) whatever it is.

For instance, I called mine (twice-then it changed, but that's another story) and they said
1. Had to lose more than 75 pounds 2.  Maintain that weightloss for at least a year 3. The panniculus must hang below the pubis 4. There must be documentation in the medical record that the panni directly impairs physical function or is medically necessary based on rashes etc.

You want to ask about reconstructive surgery.  The panniculectomy is the procedure I think that is covered the most.  This is the skin removal without the muscle tightening.

Red

You would need to ask them what is their criteria for coverage for reconstructive surgery following massive weight loss.  The types of surgeries differ.  Tummy tuck = panniculectomy; which is the removal of the hanging tummy without the muscle tightening.  This is the most common one that insurance will cover.  Abdominoplasty is for a tummy tuck with muscle tightening - this one is a bit harder to get covered by insurance.  Lower body lift is a tummy tuck, usually with the muscle tightening, an outer thigh lift and a butt lift. 

I just let my PS office take care of all that. They know how to get it through. Good luck!!

You may be able to find this info online on your insurance co's website--my insurance company refers to this document as utilization management and clinical guidelines.

Or, you could try Googling the name of your carrier along with the word abdominoplasty or panniculectomy--that would probably pull up the documentation you're looking for pretty quickly.

Best of luck!

you want to know the criteria for approval.  One thing to do is not only see if your insurance company covers it, but your employer too.  YOu might have a company intranet or your HR dept, ask for the summary plan description, that should have a list of exclusions and covered procedures and their criteria. 

good luck!