Sample letter for ins

Can anyone give me a sample letter to look at to send to my insurance company for abdominal plasty?
I like to be my own advocate and handle everything before i have the doctor sign it, and a great letter would be beneficial to me~!

Thank you!

Abdominoplasty is rarely covered unless you also have a hernia that needs repair to go along with the requirements for a panniculectomy to be covered.   A panniculectomy is basically an amputation of skin.  No shaping or muscle tightening.

For panni removal a history of skin issues documented with your doctor is usually the first step.   Then getting a plastic surgeon to submit the medical necessity for the removal.

Are you speaking about a letter of appeal once denied?  

Tom

I don't have any personal experience with insurance and plastics but here is a link to some information that might be beneficial to you. It's from Dr. LoMonaco's website.

http://www.drlomonaco.com/tips-on-getting-insurance-for-plas tic-surgery.shtml

My plastic surgeon's office handled this - I had problems because another surgeon, unbeknownst to me sent in for approval for my surgery and it was denied (of course it had no support documentation) and it really messed things up. My insurance company preferred to deal with my Drs. office over this matter and my Drs. office was on top of it so luckily it didn't affect my surgery date.

Can i get a copy of the letter and format you ise? I would love to have my doctors office use it as a guide

I will add too that in my office, we write these letters for the patient when seeking pre-authorization. I will add alos that I have to respectfully but strongly disagree with Tom above. My office has a very high approval rate for abdominal tissue removal with or without a hernia. It all has to do with the insurance plan, the physical exam and the documentation of symptoms related to the excess tissue (and any failed conservative therapies).

Good luck!

W. John Suber, MD
Foothills Plastic Surgery, LLC
Greenville, SC
SuberMD.com