DENIED

I was denied panni and arm lift. First letter say that they needed more clinical notes. Second letter said Denied due to both being cosmestic. My PCP did send a letter stating that he felt that it was needed, I don't think he put "medical necessity" though.

I have an appt with my PCP today to start the writing in the notes about back pain and such.

Any advice on what else to "complain" about since I don't really have rashes.

Thanks in advance

Does your panni prevent you from fitting into clothes properly? Inhibit your ability to exercise? Have you seen a chiropractor or any other health care professional for back pain, headache, etc.? (Headache could be from spinal misalignment caused by panni affecting posture, etc.)

My panni does NOT really prevent me from fitting in clothes.
It does inhibity my ability to exercise and my dr noted my chart with me getting back aches that were induced by the exercise.

Thank you for responding Marilyn.

DR has to very clear on the medical necesitty. You should also document the medical necessity.

Something like saw doctor for crontic rash in skins folds and doc pescribed XXXX and keep pescription receipt for documentation.  Something like excess skin on arms is much more difficult for example to prove medical necessity.  For the arms you would also need something like cronic rash or something medical.  Insurance company doesn't care if it hangs to the floor as this would be cosmedic (I know this sounds bad) so you have to look at it in turns of medical.

Jim

Thank you Jim for responding.

My PCP has sent me for PT for the chronic back pain. The PS is waiting for more documentation from my PCP, so that she can appeal.