Approved after appeal! (Aetna Open Access HMO)

After filing a 20 page appeal letter (heehee - actually 2 page letter and 18 pages of documentation) I got APPROVED today for a panniculectomy!!!

I will be getting a LBL and BL, but at least part of the cost will be covered by insurance!

You can read some of the crap I dealt with in the posts below, but basically it turned out that the PS that sent in the original request didn't send in anything about the rashes except that I said I had them.  I had given him the other Dr's names and dates of the visits to them and told him I had photos - but he submitted the package without any documentation.  So it was no wonder I got denied!

I was pretty upset, but got real busy with life and a new job then new house and almost missed my 6 month appeal window.. LOL  I submitted the appeal May 2nd and they had 30 days to reply.  I called at 5pm this afternoon and they had just made the decision - appeal overturned!  :)

Now all I have to do is decide on a surgeon.  I have one in mind (Peter Fisher), but am wondering if I shouldn't keep looking.  There are soooo many and no real SA recommendations here on the boards.  The UTHSC has a residency program that might save me a few dollars...  But not sure their experience in these types of procedures..


http://www.obesityhelp.com/forums/plasticsurgery/4262860/Confused-after-PS-consults-in-San-Antonio-long-rant-vent/

http://www.obesityhelp.com/forums/plasticsurgery/4311289/Den ied/

Congrats!

I'm a bit "anal" and want to make sure everything is done right, so I gathered all the medical documentation from my PCP myself and hand delivered it to be PS to be submitted.  Then I called the PS to  make sure it was submitted and then I called the insurance company to make sure they got it.  Then I called to check on approval and was told the insurance co still needed pics, so I called PS to make sure they sent the pics and called insurance to make sure they got them, etc.  I'm sure I annoyed the PS office, but oh well!  LOL!  Sometimes it pays to be vigilent! 

As for surgeons, I met with 4 before making a decision.  I recommend at least seeing 2 or 3 to get different opinions and perspectives and keep on meeting with different ones if you're not comfortable with something.

Good luck!

 Congratulations:)
I just got denied today for panni removal. I had letters from the bariatric surgeon, my PCP and gynaecologist. I however did not submit any documentation of rashes of pics of rashes. 
I think I have seen my PCP 4 times in one and  half year for rashes and they gave me cream for it but no pics were taken .
Can you guys please advise me what to do now. The reason for denial is that I did not have any rashes documents and pics submitted to the insurance. I was told I can appeal the decision but i need to know how to progress from here and what to get now so I can appeal it and have it approved.
Any info will be greatly appreciated. 
Thanks 

Sage,

I just sent you a PM with a copy of the appeal letter I sent in.  Hopefully it will help you in writing yours!

Best of luck!!!
Melinda

I have been denied as well and have a 2nd appeal hearing on thursday. insurance is fighting it. i have lost most of my hope. any suggestions for going into this meeting on thursday?