Medically necessary?

I called my insurance company and they said that my panny removal was covered as medically necessary. I'm starting documentation but, what all considered you medically necessary? What did you get documented?

I had the doctor record rashes and sores for every visit once a month for 6 months and each time subscribe different ointments and medical powders.  I got the panny, arms, thighs, and chest covered as all medically necessary.  We submitted pictures during approval also.  I have blue cross.

I agree with Joe, document everything. Once a month visits with your dr for treatment of skin issues caused from the overhang and rubbing. If you have any sores, ask your dr to culture them. Keep receipts from prescriptions as well as non presricption treatments. I had copies of my physician notes as well as a letter of recommendation from my dr and take pictures of any rashes or other skin issues. You will also need pictures of your pannus- front and side veiws.  My insurance required 3 months of continuous care from a dr for recurrent  skin issues. It would be in your best interest to look at your insurance policy and know what their exact requirements are. Some insurances will only approve the surgery if a hernia is present. Good luck! I am having my panniculectomy this Thursday, April 11.

I am currently writing my appeal letter and got a lot of good information from other members and my doctors (after their Peer to Peer). If you want a copy of my letter send me friend request and I will send it to you.

Irrespective of documentation, if your photos are unremarkable it is unlikely to be covered and would be cosmetic. Typically what would be required to show on photos would be intractable an panniculitis and a pannus that hangs down onto your upper thigh. Elaborate descriptions of issues but pictures with relatively stereotypical skin excess are usually quick denials by most carriers.