Great news-- but some shady math-- can you help?
I need your advice here-- surgery's June 25th.
1) Should I push about the arms and breasts now that the pannus is covered? How do I go about convincing them to bother? (My surgeon's office that is. They have all the material/photos/doctor's letters anyone could want.)
2) Bill was $18,500 with panniculectomy covered they're telling me $15, 500. Shouldn't this be even lower now if BC BS pays anesthesia and hospital costs?
3) Can I have the surgery and continue to appeal to BC BS after the fact for repayment on arms/chest?
Thanks, I'd like to hear what you think!
"Oh sweet and sour Jesus, that is GOOD!" - Stephen Colbert Lap RNY 7/07-- Lap Gallbladder 5/08--
Emergency Bowel Repair 6/08 -Dr. Meilahn, Temple U. Upper and Lower Bleph/Lower Face Lift 12/08
Fraxel Repair 2/09-- Lower Bleph Re-Do 5/09 -Dr. Pontell, Media PA Mastopexy/Massive
Brachioplasty/ Extended Abdominoplasty (plus Mons Lift and Upper Leg lift) / Hernia Repair
6/24/09 ---Butt Lift and Lateral Thighplasty Scheduled 7/6/10 - Dr. Ivor Kaplan VA Beach
Total Cost: $33,500 Start wt: 368 RNY wt: 300 Goal wt: 150 Current wt: 148.2 BMI: 24.7
April
160 lbs lost to date!
LBL: 6/10/09
BL/BA/Brachio: 7/14/09
MTL: 6/17/10
1) Yes, push for arms and breasts, people on here did and have won with the photos and evidence just like you provided. ABOSOLUTELY! 200% do it! Worst they can say is NO... submit, submit, submit. Ya just never know.
2) 18.5k for completion of TT after panni coverage, boobs and arms correct? Sounds right to me. My LBL was 10.6k after panni. I still had to pay for OR hours and anesthesia hours outside of panni. They only pay for panni operation and hours involved with PANNI.. nothing more. You pay the rest.
3) You can appeal after the fact.. but its harder to do once it happened. MUCH harder. I would start NOW. Submit it yourself if you need to but I would try to get the doc to back you up with a dictated letter stating why you need this as reconstruction after massive weight loss and not for cosemetic purposes that it alters your life and daily activities involved with daily life.
GOOD LUCK!
edited to explain: They paid 2 hours of OR time and 2 hours of anesthesia for panni. I paid the remaning 5 hours. I also paid for second night in hospital b/c first night was paid for panni - requires only 1 night. I paid for one binder, they paid for the other, etc.
http://www.onetruemedia.com/shared?p=6166c1bf498224d5a8b93e&skin_id=701&utm_source=otm&utm_medium=text_url
RNY- 12/04/06 with Dr. Matt Glasock
LBL - 4/28/09 with Dr. Rene Recinos
"Oh sweet and sour Jesus, that is GOOD!" - Stephen Colbert Lap RNY 7/07-- Lap Gallbladder 5/08--
Emergency Bowel Repair 6/08 -Dr. Meilahn, Temple U. Upper and Lower Bleph/Lower Face Lift 12/08
Fraxel Repair 2/09-- Lower Bleph Re-Do 5/09 -Dr. Pontell, Media PA Mastopexy/Massive
Brachioplasty/ Extended Abdominoplasty (plus Mons Lift and Upper Leg lift) / Hernia Repair
6/24/09 ---Butt Lift and Lateral Thighplasty Scheduled 7/6/10 - Dr. Ivor Kaplan VA Beach
Total Cost: $33,500 Start wt: 368 RNY wt: 300 Goal wt: 150 Current wt: 148.2 BMI: 24.7
However, I would think that a dictated letter in addition to submitting yourself would only help. Have you seen a chiropractor or a dermatologist? Get letters from them as well if you have to submit yourself and your surgeon will not do it (that irks me truly). It can't hurt to try even if "it never is covered". I have seen some crazy stuff get approved on this board and even in my own physical support group.
http://www.onetruemedia.com/shared?p=6166c1bf498224d5a8b93e&skin_id=701&utm_source=otm&utm_medium=text_url
RNY- 12/04/06 with Dr. Matt Glasock
LBL - 4/28/09 with Dr. Rene Recinos
Yah-- went from $18.5 for all three to 15.5k.
"Oh sweet and sour Jesus, that is GOOD!" - Stephen Colbert Lap RNY 7/07-- Lap Gallbladder 5/08--
Emergency Bowel Repair 6/08 -Dr. Meilahn, Temple U. Upper and Lower Bleph/Lower Face Lift 12/08
Fraxel Repair 2/09-- Lower Bleph Re-Do 5/09 -Dr. Pontell, Media PA Mastopexy/Massive
Brachioplasty/ Extended Abdominoplasty (plus Mons Lift and Upper Leg lift) / Hernia Repair
6/24/09 ---Butt Lift and Lateral Thighplasty Scheduled 7/6/10 - Dr. Ivor Kaplan VA Beach
Total Cost: $33,500 Start wt: 368 RNY wt: 300 Goal wt: 150 Current wt: 148.2 BMI: 24.7
http://www.onetruemedia.com/shared?p=6166c1bf498224d5a8b93e&skin_id=701&utm_source=otm&utm_medium=text_url
RNY- 12/04/06 with Dr. Matt Glasock
LBL - 4/28/09 with Dr. Rene Recinos
This was part of the reason I ended up having to have multiple (3) surgeries. In retrospect, I should have just taken the "out of network" insurance payment for the panni removal and had everything (hernia, panni, mons, TT) done at once (and then had the arms done separately).
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
Definately push them to get everything aprpoved that you can.
My surgeons office said they never get arms approved but would submit it for me if I wanted. I was approved for my arms and panniculectomy both. They were really shocked that I got approved for the arms, I had to pay out of pocket for the LBL with anchor.
Good luck and keep us posted, Debi
