Plastic and Insurance ?

Hello all,

I am just over a year out of surgery. I am 12 lbs from my goal. I have been very lucky and do not have to a whole lot of excess skin around the belly that would medically need to be removed, however I have not lost enough weight from my chest, which is contributing to some back pain. I have been seeing my PCP and now a spine specialist. I had an MRI last Friday and get the results next Wednesday. I had a medically needed reduction 13 years ago and when I gained weight and had another child I gained it all back in my chest plus some. Now that I have lost most of my weight, but hardly any from my chest I am very top heavy and will probably need another one. My question is this... Who submits the request to the ins company for approval? My PCP? The spine specialist? A plastic surgeon? I dont want to go have a consult and possibly have to pay a consult fee and find out I am going through the wrong channel for approval. Without the approval I will not be able to have one. Anyone know? And if you have a suggestion on a DR let me know. I would really like one who works a lot with WLS patients.

Thanks all for the help.

Sher

I would think your plastic surgeon would need to submit the request,since h/she will be doing the surgery. I would ask the spine specialist and the PCP for letters saying it is a medical necessity and ask the plastic surgeon to send them in with his/her request for services.
Good luck,
holly

I agree with Holly about getting the letters of medical necessity from your PCP and spine specialist and taking them to the plastic surgeon. The PS will be the one to submit the request to insurance.

Now, as for a referral...I love, love, love Dr. Lois Wagstrom in the Atrium at Centennial. Her entire staff is female and just as wonderful as she is. She did my LBL with anchor cut and hernia repair 2 1/2 years ago and I am still just as thrilled with my results as I was immediately after surgery.

I hope to be able to have my girls done but I just want them put back on my chest and the side/back boobs removed. Dr. Wagstrom even understands when we ask her to preserve the nerves to the nipple if at all possible.

She has vast experience with WLS patients and has multiple pictures to document her work. They will even put you in contact with a patient if you want to talk one on one with someone with a situation similar to yours.

Sher ~

I had a medically necessary breast reduction   (although they look great!  lol) with Dr Reddick in Kingport 7 years ago.  A friend of min had it done with great results, I asked my PCP to  refer me to him, went to him for a consult and his staff submitted whatever paperwork was necessary to my insurance for approval.  Had the surgery, would do it again in a minute!  Best thing Ive done for me to date!

Hi - I am an RN case manager with a nationwide insurance company. Just fyi: the person who will have to submit paperwork for approval is the surgeon requesting/performing the surgery. He/she will have to use supporting documentation (from himself and other practitioners) for the approval, which can be easily faxed in from the provider's office. You may want to gather all of the supporting medical records yourself and give them to your surgeon, ask them to submit that along with their own documentation for approval. You should be good to go. They can't argue with facts. If tney deny it, appeal it. Most surgeries are approved upon appeal. Good Luck.