how much documentation did you submit for approval???
I didn't submit anything. My doctor wrote a letter, and maybe sent pictures, but after two denials, I got a surprise approval and the ball rolled after that. I had to pay for my arms but the panniculectomy was covered. I still don't know why, but I didn't question it!
Gay L. The voice of the sea speaks to my soul
Since you have So. Cal Kaiser, it is really based upon the opinion of your primary to refer you and to the plastic surgeon to come up with what you will need and what is necessary. My understanding is that So. Cal Kaiser doesn't necessarily go by rashes anymore, but the amount of overhanging skin. If you are requesting to be seen at WLA, then it is up to the PS who will see you there - most likely Dr. Lee, who I would strongly recommend, or Dr. Touran, who is also very good. Just make sure to contact your primary via the email system at Kaiser each time you have a rash issue, and ask if you need to be seen. Also ask for more creams. If you are having a problem under your breasts with rashes, photo document that and ask your doctor to look at it, and ask to see a dermatologist about it too. Kaiser will not cover a tummy tuck, only the panni portion, but at WLA with Dr. Lee or Dr. Touran you can get a tummy tuck by paying the difference. Breasts are another issue, and I'm one of a very, very few who got the lift covered due to severe rashes that I had from the 3rd month after my bypass until my consult with the first plastic surgeon here in Ontario. Dr. Touran, who is doctor I first saw at WLA approved my panni and breast lift, and said that I really needed to see Dr. Lee for a belt lipectomy lift. Once I saw him, he did let me know that I was fully covered for the pannilectomy and for the breast lift, but I paid an additional fee for the auto augmentation of the breast, which I recently found was mostly skin and some fat that remained connected from my abdomen area. I also paid for the upgrade to the belt lipectomy.
Kaiser So. Cal is pretty easy to get the panni through as long as your primary refers you. I think I mentioned to you before you can also self refer to WLA, pay the consult fee and if Dr. Lee feels that it should be covered for panni, he can get that approved.
Kaiser So. Cal is pretty easy to get the panni through as long as your primary refers you. I think I mentioned to you before you can also self refer to WLA, pay the consult fee and if Dr. Lee feels that it should be covered for panni, he can get that approved.
Jennie
31 lbs lost before surgery
31 lbs lost before surgery
Thanks again...It is getting so close to my 1 year out I need to get rolling. OK so I went to Kaiser yesterday because my lower left side is killing me and I think I have stones.. I have to get an ultrasound tomorrow or Friday for that diagnosis. They looked at my rash and gave me a cream. The doctor, not my primary doc said"if this does not work please let us know". Off I went home.
So in your opinion, my next step should be what???
To go see my primary for a referral??? He has said he will send it to whoever...do you have Dr Lees fax number is that the best way to send the paperwork???? Or I could call Jene Miles for that info???
Also in your opinion should I be fighting to see a dermatologist????
Finally I was curious is Dr Lee on our side??? will he work hard to get an approval? or to save Kaiser money?
When you look at my panni it is obvious that it hangs. But I have seen worse. It hangs worse than this pic of the torso to the right of the screen. he before and after tummy tuck pic. Totally worse!!!! I just really want this covered !!!!!
Thank you sooo much if not for you emailing me for the last 9 months about this stuff I would have never thought to fight for Kaiser to cover it!
So in your opinion, my next step should be what???
To go see my primary for a referral??? He has said he will send it to whoever...do you have Dr Lees fax number is that the best way to send the paperwork???? Or I could call Jene Miles for that info???
Also in your opinion should I be fighting to see a dermatologist????
Finally I was curious is Dr Lee on our side??? will he work hard to get an approval? or to save Kaiser money?
When you look at my panni it is obvious that it hangs. But I have seen worse. It hangs worse than this pic of the torso to the right of the screen. he before and after tummy tuck pic. Totally worse!!!! I just really want this covered !!!!!
Thank you sooo much if not for you emailing me for the last 9 months about this stuff I would have never thought to fight for Kaiser to cover it!
"People are healed by different kinds of healers and systems because the real healer is within." - George Goodheart
He should send your referral to WLA plastics for referral. Call Jene back and ask her if there is a certain number, but I believe he can send it to WLA through the health connect system when he puts your referral into the system. They will cover your panni - almost without a doubt, with the referral. There is no way to get more covered. Dr. Lee is a great guy, and he warms up the more you see him. Your consult might be more just business, but as you get to know him, he really warms up. I love him, but I've had almost 2 years of experience with him. We are pretty comfortable with each other now. He will approve your panni if you have the referral, and it hangs over your pubic bone. If the rash doesn't to away, ask to see a derm, but that might delay your plastics referral. You cannot have surgery with a ra**** has to be cleared up first, and that might be a reason to ask for a derm. My primary sent me to a derm early because of the rashes. I saw him for 6 months, and his notes plus the horrible rash under my breasts got them covered.
The panni, for So. Cal is easy to get covered if there is hanging skin and it is causing an issue which no longer has to be a rash. Might interfere with movement, exercise, or sex. Don't stress the panni or try too hard oto justify it it, cause it isn't like other Kaiser regions. It is easier here than you think. Dr. Lee has quite a bit of compassion on those of us who have lost lots of weight. He does want you weight stable - no longer losing and certainly not gaining. He does want you healthy and working out as well. i don't know how many basic pannis he does but will do the upgrade fee for service. Those are only done on Saturdays as a tummy tuck or lbl. If you are only wanting a panni, then the referral to your local plastic surgeon through Kaiser will also get you that. It really isn't that much of an issue here anymore with the referral. You don't have as many hoops and as long of a wait with WLA - or at least I didn't when I saw them 20 months ago for my referral. You do have to wait to get an appointment for that, and if you want Dr. Lee, his schedule is tight, and it can be a wait to get in. He sees patients there on mon and wed mornings - until noon, and Friday mornings and afternoons. Most Tuesdays and Thursdays he is in surgery, sometimes other days of the week as well. And Monday afternoons, he does in office surgery at the Los Angeles offices, and Wednesday afternoons at WLA.
If your primary thinks you have an issue with the extra skin needing to be removed by a plastic surgeon here in So. Cal, you can get that covered. Remember the panni is not cosmetic and they don't do your muscles. They would prefer you upgrade to the tummy tuck to offer you a much better outcome. They will apply the panni portion to the tummy tuck.
Did you already call Jene and speak with her? She can probably give you more info if needed. I do have Dr. Lee's fax and office numbers, and email addy but I think Jene can give you more info on the steps to follow.
I think that I pm'd you my cell number - I will send it again and maybe we can talk and that will help you more.
Jennie
The panni, for So. Cal is easy to get covered if there is hanging skin and it is causing an issue which no longer has to be a rash. Might interfere with movement, exercise, or sex. Don't stress the panni or try too hard oto justify it it, cause it isn't like other Kaiser regions. It is easier here than you think. Dr. Lee has quite a bit of compassion on those of us who have lost lots of weight. He does want you weight stable - no longer losing and certainly not gaining. He does want you healthy and working out as well. i don't know how many basic pannis he does but will do the upgrade fee for service. Those are only done on Saturdays as a tummy tuck or lbl. If you are only wanting a panni, then the referral to your local plastic surgeon through Kaiser will also get you that. It really isn't that much of an issue here anymore with the referral. You don't have as many hoops and as long of a wait with WLA - or at least I didn't when I saw them 20 months ago for my referral. You do have to wait to get an appointment for that, and if you want Dr. Lee, his schedule is tight, and it can be a wait to get in. He sees patients there on mon and wed mornings - until noon, and Friday mornings and afternoons. Most Tuesdays and Thursdays he is in surgery, sometimes other days of the week as well. And Monday afternoons, he does in office surgery at the Los Angeles offices, and Wednesday afternoons at WLA.
If your primary thinks you have an issue with the extra skin needing to be removed by a plastic surgeon here in So. Cal, you can get that covered. Remember the panni is not cosmetic and they don't do your muscles. They would prefer you upgrade to the tummy tuck to offer you a much better outcome. They will apply the panni portion to the tummy tuck.
Did you already call Jene and speak with her? She can probably give you more info if needed. I do have Dr. Lee's fax and office numbers, and email addy but I think Jene can give you more info on the steps to follow.
I think that I pm'd you my cell number - I will send it again and maybe we can talk and that will help you more.
Jennie
Jennie
31 lbs lost before surgery
31 lbs lost before surgery
I am in tears I can actually get this covered!!!! I am going to do everything possible to get this covered. Wow, thank you sooo much!!! Yes I called Jene she told me that currently Dr Lee is 6-8 weeks backed up for a consult. Then It will take 2 weeks to get covered for the panni. I am not 1 yr out yet. On Feb 12th I will be 1 year out. but I am weight stable and at goal. Can I start the process now since I wont see him for 6-8 weeks. Because that would put me at 1 year by the time Dr Lee see's me?????
Ok well I will wait to make my appointment with my Doctor until I hear from you. Thank you soooooooooooooooooooooooooooooooooooo Much Jennie
Ok well I will wait to make my appointment with my Doctor until I hear from you. Thank you soooooooooooooooooooooooooooooooooooo Much Jennie
"People are healed by different kinds of healers and systems because the real healer is within." - George Goodheart
Did you get my number in the pm? If so, please call me.
You MUST BE 12 MONTHS post op and weight stable to be referred for plastics. The panni coverage requires this. You can self refer ahead of time, but you will have to pay the higher consult fee. I would make your appointment with your primary to fall just after your 12 month mark and ask him to refer you for plastics consult for possible panni removal at WLA. Once WLA gets that, they will call you for an appointment, or you can call their appointment number a few days after the referral goes through.
If you want the Tummy Tuck upgrade, you can self refer early, pay the $100. consult fee, which will be applied to your procedure with Dr. Lee, and make the appointment now through Jene. If Dr. Lee feels that he can justify the panni portion for you, then he will do that. It's up to you on that. I don't think that Dr. Lee does too many panni removals, but I may be mistaken. I think he usually takes bigger, more complex cases. He has made some comments in the past that he isn't a fan of the panni - as most plastic surgeons are not. It is not a cosmetic procedure, and the aesthetics are not to be considered that much.
Once you decide to do the tummy tuck or LBL with Dr. Lee, you call Jene back to get a date. It will take her a week or so to do that, depending upon Dr. Lee's available Saturday schedule. The fee for service upgrades are only done on a Saturday, and they are also done with residents from the USC program assisting Dr. Lee. I've been quite impressed with the residents that I've met - particulally Dr. Lubbers, Dr. Dhillion, and Dr. Carey.
Oh, and when you see Dr. Lee - tell him hello from me - although I will probably see him first - my next recheck is Jan. 22
Give me a call and we can talk more
You MUST BE 12 MONTHS post op and weight stable to be referred for plastics. The panni coverage requires this. You can self refer ahead of time, but you will have to pay the higher consult fee. I would make your appointment with your primary to fall just after your 12 month mark and ask him to refer you for plastics consult for possible panni removal at WLA. Once WLA gets that, they will call you for an appointment, or you can call their appointment number a few days after the referral goes through.
If you want the Tummy Tuck upgrade, you can self refer early, pay the $100. consult fee, which will be applied to your procedure with Dr. Lee, and make the appointment now through Jene. If Dr. Lee feels that he can justify the panni portion for you, then he will do that. It's up to you on that. I don't think that Dr. Lee does too many panni removals, but I may be mistaken. I think he usually takes bigger, more complex cases. He has made some comments in the past that he isn't a fan of the panni - as most plastic surgeons are not. It is not a cosmetic procedure, and the aesthetics are not to be considered that much.
Once you decide to do the tummy tuck or LBL with Dr. Lee, you call Jene back to get a date. It will take her a week or so to do that, depending upon Dr. Lee's available Saturday schedule. The fee for service upgrades are only done on a Saturday, and they are also done with residents from the USC program assisting Dr. Lee. I've been quite impressed with the residents that I've met - particulally Dr. Lubbers, Dr. Dhillion, and Dr. Carey.
Oh, and when you see Dr. Lee - tell him hello from me - although I will probably see him first - my next recheck is Jan. 22
Give me a call and we can talk more
Jennie
31 lbs lost before surgery
31 lbs lost before surgery
Most Active
Recent Topics
