Long insurance battle**I won!
I have Blue Cross/Blue Shield and my plastic surgeon sent in an approval for my surgeries over a year ago. I got denied and sent in appeals and even went as far as to the Attorney General. In the response to the Attorney General's letter they wrote the decision is upheld and I was denied because the request was for surgeries that were concidered cosmetic and that I can issue a new approval for different procedures. This got me thinking, all my appeals were for surgeries that were not covered so they did have the right to deny me. So I found the procedures that they cover, revised the letter the doctor sent, and asked for my surgeries in the form that Blue Cross would cover. In only 2 weeks I was approved for all my surgeries. Medial arms, upper thighs, chest, and pannecutomy. If you have trouble with approval make sure you ask for the correct procedures.
>>>Approved!!! Surgery 10-19-09<<<
Starting an improved new me
I have Blue Cross/Blue Shield of Minnesota. I called blue cross and asked them to send me their policy on weight loss surgery and they sent a section that including the coverage for excision of redunt skin do to weight loss from surgery. This is the letter that I sent that got approved:
This letter is to serve as a request for surgery for Excision of Redundant skin due to extensive weight loss regarding the above-named patient, Mr. Joseph Carson. This request is for Excision of Redundant skin involving his abdomen, chest, and medial arms and thighs. This request is for prior approval for the following procedures; 1:)CPT:15830 Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy 2:) Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area (Chest)3:)CPT:15832 Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh 4:)CPT:15836 Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm. CPT codes are listed for reference.
I had been seeing Mr. Carson almost monthly for past year with chronic recurrent skin infections involving the groin, lower abdomen, chest wall beneath the chest wall tissue, and also his medial arms and axillary region. We have tried multiple anti-fungal, anti-bacterial, and absorbent agents on these areas without complete resolution of the infections and irritations. He has continued using these products as well as over-the –counter items such as powders, absorbent pads, and creams with the same results. We have attempted to get him a gynecomastia vest to help with the chest wall tissue so that he could become more active in his activities of daily living and exercises which would only help him continue with the weight loss that has resulted from the extensive bariatric surgery he had done in 10/2009.
All of our attempts at treating these infections have continued to fail and therefore I feel like his skin infections are indeed intractable to medical therapy at this point. Surgical excision of this excess skin tissue would be the only logical choice for treatment so that he can indeed get on with his life and be more active which was the point of the initial surgery.
We are referring him back to the Mayo Clinic department of plastic surgery for consult regarding these procedures but will await your decision for final appointment dates.
If you should have any further questions or concerns regarding Mr. Carson, please feel free to contact me. We will be forwarding you all of the office notes related to his care over the last year. Thank you in advance for your assistance in his care.
*****The letter from the surgeon pretty much asked the same thing but he used cosmetic terms such as mestoplasty or something like that. You need to spell out pretty much what there policy asks for.
>>>Approved!!! Surgery 10-19-09<<<
Starting an improved new me
