PS approved after initial denial....approved everything!!!!

pmann8
on 6/1/12 11:33 pm

I had RNY in March 2009 and have gone from 477 to 247. Lots of skin breakdown and excess bags of skin impairing exercise and mobility. Saw PS at RNY surgeons suggestion and he submitted req for Panniculectomy, abdominoplasty, and thigh lift. He was hoping they would cover panni at least....initial req was denied . I submitted 12 color pics, dr statements of skin problems and letter of appeal requesting reversal of decision. It was rec'd by certified mail on May 22 and today, June  I rec'd a call from the appeals mgr stating that the appeals committee had reversed their decision and I received a statement saying the entire proceedure had been approved. My doctor will schedule surgery when they open Mon morn and call me
with date. Dr nurse was amazed that the entire proceedure was approved since I was prepared to pay for thighs out of pocket.My main reason for posting is to let you know to not give up!! Appeal if needed and have documented backup for your appeal. For those of you who will ask: I am on a Medicare Advantage plan and the orig denial said it was "cosmetic" I copied and highlighted their own manual as well as the Medicare manual which states "proceedure is cosmetic UNLESS medically necessary. Hang in there when you think you are right!!!!!


                    
MissCamp26
on 6/2/12 12:18 am
Congratulations! I am so happy for you. I considered myself very fortunate to have had my abdominalplasty approved, so it's wonderful to know that someone hit the jackpot... :)
LoriD70
on 6/2/12 12:52 am - Fort Lee, NJ
Congratulations!  Do you have a surgery date?
godzilla
on 6/2/12 1:12 am - Israel
Fantastic news for you!
Always be willing to fight for what we deserve!
But also take a look at what your HMO/ insurance will cover in order to word your claim efficiently.
I fought after denial twice - TT and now for Mastopexy.
Mikmi in Israel
sharonleanne
on 6/2/12 1:41 am
 Congratulations!!!! That is so exciting!!!! The waiting and fighting is a very stressful process, but what a great outcome.  Oh ya, I am doing the happy dance for you. Hopefully I will be doing a happy dance for myself too. 
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