need advice re: insurance letter

Hey all! Just got my letter today. Says they will approve hernia repair but not panniculectomy as they have no documentation of skin disorders for medical necessity. My question is, and I am so dense about insurance, is this. Is it just the cost of the procedure itself that is in that denial? If the hospitalization would be covered and Dr S. would waive his fee for the panni which he once offered to do maybe I should consider it. I have three months before this certification runs out. My deductible is already met. How would the anesthesiologist bill be split between the two procedures if they are done at the same time?!?!?!? Insurance info is like a foreign language to me. Guess I just need to make some phone calls and ask some questions-- dumb ones or not. Lucy

I tried that, in CA they can not do anyother procedure while doing the approved procedure or it nullifies the whole thing. My suggestion is talk to the ins person in your MD's office or business office person in your MD's office. Do not speak to the ins, first. they may make notes to your file that make it impossible for you to even get what you already got approved before. If you ready that letter, it probably says that it is covered, but the letter is not a guarantee of payment. All my luck to you. Ins. stuff is sooOOO confusing. I think they do it on purpose. Stacey

Thanks so much for you reply and I will call the docs office first. I see in your profile something about big plastic surgery troubles. Would you mind telling me your story. You can e-mail me if you wish. Thanks again! Lucy [email protected]