Insurance Approval?

My PS has sent in the paperwork for insurance approval for my panni removal. I haven't had rashes because of keeping it dry and covered with Gold Bond powder several times a day. He told me that because I have lost over 100 pounds and the length of the "hang" he thinks I will be approved but they will help me with an appeal if not.

My question is..... they told me 2 to 4 weeks for approval. My WLS approval came within days. Does the PS approval usually take longer than approval for WLS?

I am also going to piggyback BA with the panni removal on my own dime, what is the recovery (back to life) time from that kind of surgery. I forgot to ask that during my consult. I guess my head was in a fog choosing my boobie size .

Thanks for any help you can give me!

Martha

Mine was through Aetna and it took a couple weeks to get an answer and even then they wanted "additional info" so took even longer... Even when I through I dotted my i's and crossed my t's of what they wanted based on their requirements, they are so darn picky.  It could be days or a couple weeks.. I remember the "waiting game" its tough! lol... soon you will know tho.

Can't comment on the recovery with breasts.  LBL is a bit more than a panni as far as recovery time so I won't even comment on that either as that is what I had done.  I know my doc does require 6 weeks off for panni if you job involves lifting which mine does.

Keep us posted!

Martha... Does this PS participate with your insurance... If so you may want to ask them about the piggy backing....... If he participates it will probaly have to be 1 or the other... The insurance approved panni or the pay your own TT... here's why........

when a provider participates with an insurance company they have agreed to only bill the patient up from for any out of pocket expenses (copay's, coinsurance etc)..., they have also agreed to bill the insurance and ACCEPT the insurance payment as PAYMENT IN FULL for services rendered... therefore they CAN NOT balance bill the patient.

When billing an insurance company every surgery has it's own 'procedure' code... which is what the surgeon is paid based upon..... Therefore legally your surgeon can not perform 1 surgey and bill for a different surgery and then balance bill you the difference. Additionally, they can not balance bill you the amount that would have been a contractual write off for the approved surgery... Here's an example in #... Say your surgeon normally bills 5K for a PE.... 10K for a TT... Your insurance allows 2500 for a PE and your out of pocket expense is 500..... If you just had the PE you would be paying your surgeon 500... But with the piggy back procedure, You are now responsible for 8K.... whereas normally 2500 of that would be a provider's contractual write off that you WOULD NOT have been responsible for.....

Allow me to suggest this... Before you make any decisions.... wait and see 1st if your insurance is going to cover the PE.... If they do..... have a long talk with their provider relations dept re: the piggy backing.. You don't want to be held liable for monies that normally your surgeon would be reponsible to legally write off... Also ask them if 'under his contract with them' if he even can upgrade and then bill for a different procedure.

Good Luck !!!

Hi Lisa,

Thank you for the information. What I wanted to piggyback is a BA, not a TT. I think that the PE is fine for me so there would not be any insurance issue for the PS doing a procedure that was different from what is approved  (hopefully) by my insurance.

Martha