Need Verbage help with UnitedHealthcare!!

Thought I would change to Aetna,,but they are staying with United healthcare... drats,, aetna was easier I think..

So now I need to do an appeal and need verbage.. I know it needsto be reconstructive and know there are some codes that cannot belisted,,,

Does anyone have a clue what is better ??

Thanks deb

You need to document with tour PCP chronic irritations/iUlcerations that are unimproved with meds. With a little ingenuity you can help your Doc. diagnose this. These areas are painful, odorous,inhibit exercise, bleed, stick to your clothes, extremely painful to shower, interferes with sleep, embarrassing, and is a systemic source of infectiion throughout your whole body.Everyone is anatomically different. Their one size fits all about hanging skin to your pubic area will be dis-credited and trumped by your symptoms Send your appeal by certified mail with conformation of receipt. Beat them at their own game and be relentless. Don't give up... They will pay for it twice to just get rid of you. They have automatic denials in hopes that you'll self pay. IF YOU ARE DETERMINED YOU WILL WIN

Thanks for reply! I have over 40 pages of office visit photos etc
Went to one consult, they only requested , then used a cpt that was
For disectus recti?? And that one is specifically not allowed. That
Is why I was searching for other cpt codes that apply

15830 is the CPT code for Panniculectomy 15847 is the code for adbominoplasty.  I got approval through BCBS on the first go and I provided my perscription records showing all the antifungals and steroids, my doc wrote a letter and I got my records from his office.  I also had my hubs take pics of all the rashes and irritations.  I wrote a letter descrbing how it interfered with my life.  The steroids and antifungals caused my skin to peel off in sheets so I would then get lesions that were painful.  Putting on clothing hurt, touching hurt,  I couldn't play with my kids, couldnt exercise.  I demonstrated that i had been going through this for 2 years and nothing stopped the rashes.  I demonstrated how much wound care and perscriptions cost me each month.  I also used a special blend from a compounding pharmacy that didn't work and I showed that as well.

Another thing is to get support from non-traditional medical personnel. I was told that what pushed mine through were referrals from a breast specialist at my gyny who diagnosed a torn chest wall muscle that would not heal unless I had breast reduction/lift and brachioplasty, a referral from my orthopedic surgeon that the hanging skin on my thighs was impeding my ability to move without damaging joints, and then one from my physical therapist that the hanging skin on my legs, abdomen and arms was preventing me from moving appropriately to maintain health. I also had my PCP document not only the rashes in folds, but also repeated navel infections. Some people have reported luck in adding a psych letter documenting the emotional difficulty from being unable to live a healthy life due to excess skin (although I hear this doesn't work nearly as well if you need lipo as well).

Best of luck with it!