Approval twice

KANKAKEE
on 2/16/11 11:26 am

In Nov 2010 i went to my first ps consult and in two days i was approval for the code 15830 thats pann only. At first i was ok with that and we talked about the ftt with add of 3500, so i guess i asked to many ? for him and jokely said if i get up and my abd was not flat i was going to clear out the or room (of course i was playing around i work there at the hospital so we all know eah other) so 2 weeks go by and we set and date for 3/11 the dr call me early one moring as said don't hate me but i can't do you ps!!!!! I said and why not he said he did not know why it't just something i the back of his head telling him not.....  Anyway i was sent to Chicago for what he wrote and told the isc that he wanted ans 2nd opinon!!!!!!!!!!!  Now 2/11 the dr put in for  codes 15830 15847 15834-50 15835-50 15836-50 15832-50 and 19316-50 and only in 4 days yes they said yes, now the only thing i hate is i can't have it done till may 2011 due to the dr going on vacation and now i have to request time off and thats the only time i could be off for 12 wks. My request letter the dr wrote was just and few lines and thats it thats all. So if anybody want and copy i will put word from word and hope this would help many others. 

too.busymom
on 2/16/11 12:15 pm
Congratulations!
I would love to see the request letter, if you wouldn't mind sharing.
    
KANKAKEE
on 2/16/11 1:26 pm
Ms.? underwent gb surgery seven years ago. She weighed 380 pounds and now she weighs 180 pounds. Her bmi has gone from 58.7 to 32. She has a history of uvetitis ((eye dis) and was taking steroids for thirteen months but now she has been off of the steroids for six months. She has a large pannus, mulitple back roll, excess skin of the hips and buttocks. She has Grade III ptosis of her breasts and excess skin of her arms and thighs. Because of the multiple rolls and excess skin, she has intertrigo and difficulty wearing clothes. She is in need of a staged reconstruction. The first stage will be excision f the pannus, or abdominoplasty, excision of the excess skin of the hips and buttocks and multiple rolls of her flanks. She will also need excision of the multiple rolls of her back. This should relieve the symptoms in these areas. The second stage of her reconstruction will be excision of the excess skin of her arms and thighs. She wil also need a mastopexy to correct the Grade III ptosis of her breasts. She needs correction of her Grade III ptosis which causes neck pain and shoulder pain and the mastopexy should relieve her symptom.

I look forward to hearing from you. Please feel free to call or write me anytime forfuther information or assistance.

The CPT codes are 15830,15847,15834-50,15835-50,15836-50,15832-50 and 19316-50.
sadiemorgan
on 3/31/11 2:52 pm - IL
I had the gastric bypass surgery and the insurance denied medical codes 15830, 15847, 15834-50,15835-50, 15836-50, and 19316-50. Can someone share with me their letters of appeals. My breast now is hanging down close to my navel. Hips are unusual deformity with overlapping fat. Shoulder hurts because of the pulling down from the breast. My butt is hanging with rolls that give me rawness. I can't sleep comfortable because of the pinching of the fat. I have bat wings. I probably have a total 20lbs or more of fat hanging. I know they don't want to pay for this..But I need it. They claim it is cosmetic surgery. Yes it is but, it's for deformity!!!!! PLEASE HELP!!!! I am so embarrass and ashamed. My face is small and my top is a size 8 and my bottom is a size 18. Thank you for your help.
I had the gastric bypass surgery and the insurance denied medical codes 15830, 15847, 15834-50,15835-50, 15836-50, and 19316-50. Can someone share with me their letters of appeals. My breast now is hanging down close to my navel. Hips are unusual deformity with overlapping fat. Shoulder hurts because of the pulling down from the breast.  My butt is hanging with rolls that give me rawness. I can't sleep comfortable because of the pinching of the fat. I have bat wings. I probably have a total  20lbs or more of fat hanging. I know they don't want to pay for this..But I need it. They claim it is cosmetic surgery. Yes it is but, it's for deformity!!!!!  PLEASE HELP!!!! I am so embarrass and ashamed. My face is small and my top is a size 8 and my bottom is a size 18.  Thank you for your help.
wigglypoo
on 2/17/11 10:26 am - Sturgis, MI
 Great that you got approval for all of those things- Do you mind telling me what type of insurance you have? We are in the process of changing and I appreicate knowing ones that are "decent to work with for getting approval,
Thanks.

Amy
sadiemorgan
on 3/31/11 2:49 pm - IL
KANKAKEE
on 2/17/11 5:08 pm
BCBS IL HMO
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