letter of necessity

I am in the process of submitting to my insurance company to cover my TT.  I have the usual rashes, excoriated areas etc etc...does anyone have a letter that they used to help convince their insurance company that they need to have the surgery convered?   I would appreciate it so much if anyone can share their info!!

kim

Generally the surgeon takes care of that.  Have you been told that you need to write a letter?

Here is a letter that I copied and pasted from this forum a few weeks ago.

This was posted awhile back by one of our active Plastic Surgeons on this board, Dr. LoMonaco.

I saved it just in case it would be helpful.

Copied and pasted.....


Just as an example, here is what we write:

-------------------------------------------------
Dear INS company,

Please find the records of Ms. Chelsea attached.  As you can see, she was seen December, January, and March by Dr. Smith for skin rashes and dermatitis of the ________ area(s). Each time, she was provided prescriptions for __________ which did not adequately control her skin problems (They already have a record of this BTW because they are paying for it).   Her skin problems have been recurrent in spite of the treatments she has bene given.

I propose to remove the excess skin of the ________ to permanently remedy her skin infections, which have not responded to the above medications in spite of several months of treatment.

I feel that surgery is the only available option that will result in a permanent correction of this patients skin conditions, which have nagatively affected her quality of life.
----------------------------------------------------

The plan language of nearly all the maor carriers asks for this quite specifically, so I advise patients seeking coverage to "do what the plans want" in order to get coverage. Often there is confusion over what the term "documentation" means, and that does not refer to a letter alone.  They want office visits, prescriptions, and any other proof that you went to the doc for your skin issues.

Hope this helps and good luck,

Dr. L.
 

Here is a link to the actual thread     http://www.obesityhelp.com/forums/plasticsurgery/3982173/Denied-once-trying-again/
Renee


Submitted this time by Diana 10/3/09

thank you so much for the info...

kim

I hope it helps Kim. I'm getting ready to start the same process that you are. I go to the PS for my first visit on 10/22.

Diana

Diana:  I hope things go well for you on your first initial visit..its quite exciting!!  I may have to end up paying for my TT out of pocket, have already been denied once but currently am appealing and have pics/documentation so we will see.  Im going to a resident clinic so will save lots of money anyways...keep me posted and good luck!
kim

Hi Kim,

Praying that you'll be approved this time around. Hopefully my insurance company will pay for my panni removal. The PS I will be seeing evidently has quite a bit of experience in getting my type of health insurance to cover the surgery.

Diana