Plastics Through Kasier Question

I was just referred to plastics  and Kaiser is my provider.  I have the class they make you attend that is 2-3 hours next Thursday and then I get to see the plastic surgeon.  They will cover a panniculectomy 100% for me, but I really need a full abdominoplasty.  My friend just had her panni two months ago through Kasier (the same facility I go to, actually) and she said that they give you a list of plastic surgeons that work with Kasier if you want to take the money they would put up for the panni and then pay the difference.

I'm so very curious as to what the difference is (on an average) for doing the full abdom instead of the panni.  I'd like to get an idea of what I'll be facing financially and what the process is like through Kasier.  Does anyone have any epxerience with this?  I'd really aprpeciate any feedback.  THANKS!

Wowww,, sounds like a good deal and I'd grab it if it were me.

I have Kaiser also and was never given an offer like that. I was told panniculetomy or find your own plastic surgeon that'll do the TT also.

I was also told NO to the breast lift (reduction covered only), & arm lift.

No offers to help me in any way.

PamT

the difference is money is about 3000.00.
Personally the difference with the full abdominoplasty is amazing
good luck to you
Susan

WOW, that's awesome and SO doable.  Thank you!  I really hope the difference for me is like that, because that is something I can swing.  Did you go through Kaiser?

California law mandates coverage of reconstructive surgery WITHOUT medical necessity.  You should appeal and try to get ALL of your reconstructive surgery covered.  I have a template letter you can use to get a NON-KAISER reconstructive surgeon to verify that your condition meet the terms of the statute:

California Health and Safety Code

 

1367.63. (a) Every health care service plan contract, except a specialized health care service plan contract, that is issued, amended, renewed, or delivered in this state on or after July 1, 1999, shall cover reconstructive surgery, as defined in subdivision (c), that is necessary to achieve the purposes specified in paragraphs (1) or (2) of subdivision (c).  Nothing in this section shall be construed to require a plan to provide coverage for cosmetic surgery, as defined in subdivision (d).

   (b) No individual, other than a licensed physician competent to evaluate the specific clinical issues involved in the care requested, may deny initial requests for authorization of coverage for

treatment pursuant to this section.  For a treatment authorization request submitted by a podiatrist or an oral and maxillofacial surgeon, the request may be reviewed by a similarly licensed

individual, competent to evaluate the specific clinical issues involved in the care requested.

   (c) "Reconstructive surgery" means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following:

        (1) To improve function.

        (2) To create a normal appearance, to the extent possible.

   (d) "Cosmetic surgery" means surgery that is performed to alter or reshape normal structures of the body in order to improve appearance.

   (e) In interpreting the definition of reconstructive surgery, a health care service plan may utilize prior authorization and utilization review that may include, but need not be limited to, any of the following:

        (1) Denial of the proposed surgery if there is another more appropriate surgical procedure that will be approved for the enrollee.

        (2) Denial of the proposed surgery or surgeries if the procedure or procedures, in accordance with the standard of care as practiced by physicians specializing in reconstructive surgery, offer only a minimal improvement in the appearance of the enrollee.

        (3) Denial of payment for procedures performed without prior authorization.

        (4) For services provided under the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), denial of the proposed surgery if the procedure offers only a minimal improvement in the appearance of the enrollee, as may be defined in any regulations that may be promulgated by the State Department of Health Services.