Yeah! Appeal Approved
I'm so happy. My Dr.'s office just called to let me know they just received a letter stating my panni removal has been approved. This was originally denied and I sent in one appeal letter at the beginning of Dec. I can't tell you how excited I am about this since according to some of their requirements I didn't qualify. I think the biggest point on getting the approval is that I called the insurance company prior to going in for surgery and stated what surgery I was going in for and if I needed prior approval. I was told no and never told about any of their requirements for having this covered (ie. stable weight for 6 months, 18 months post-op and such) just to go have the surgery and have the Dr. submit the claim since it was originally for a less than 24 hour hospital stay. Oh well, guess it never hurts to try to get things approved even if they were denied the first time.
Sonya
Sonya
Good for you! Congrats!!
TT, BL/BA, Lipo, FG/Booty, and small TLcompleted with DR Sauceda
SW 201 / GW 134 / LW 129 / CW 137.6
http://tammygirlsjourney.blogspot.com/
SW 201 / GW 134 / LW 129 / CW 137.6
http://tammygirlsjourney.blogspot.com/
Yolanda
I used the letter posted by workingmommy here http://www.obesityhelp.com/forums/plasticsurgery/4025604/Bec ause-so-many-have-asked/#32630305
I just added that I had called for a pre-approval and was told I didn't need one and to just have the procedure. They never told me the requirements that my insurance had to cover the surgery ie. 18 months post op, documented rashes, stable weight. I let them know that I had been at a stable weight for 6 months and my body fat % and lbs of fat were normal. Also included that the hanging panni was causing me discomfort in my back and it was hindering me in my exercise which was crutial to maintaining my weighloss. I also had sebatious cyst that were deep under the skin in the mons area due to the panni hanging and pressing there and that all these things have been resolved since the surgery.
Hopefully this helps you in your efforts at an appeal.
Sonya
I just added that I had called for a pre-approval and was told I didn't need one and to just have the procedure. They never told me the requirements that my insurance had to cover the surgery ie. 18 months post op, documented rashes, stable weight. I let them know that I had been at a stable weight for 6 months and my body fat % and lbs of fat were normal. Also included that the hanging panni was causing me discomfort in my back and it was hindering me in my exercise which was crutial to maintaining my weighloss. I also had sebatious cyst that were deep under the skin in the mons area due to the panni hanging and pressing there and that all these things have been resolved since the surgery.
Hopefully this helps you in your efforts at an appeal.
Sonya
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