Pre-determination sent for doctor reivew plastics

I had consult with plastic surgeon on June 8, 2004 they sent pre-determination letter in the very next day and I still havent heard anything. My plastic surgeon's letter stated Patient was seen today for plastic surgical consultation regarding abdominal wall weakness and abdonimal panniculus. The patient is a 30 year old female that is 5'7" tall, weighing 146 pounds who upon examination presents with significant overhanging abdominal panniculus with associated sub panniculus intertrigo. She also has a wide rectus diastasis, which is causing significant abdominal wall weakness. The abdominal panniculus and its associated weakness, severely limits her ability to exercise which she needs for continued weight loss and general health maintenance. The patient has: 728.84 diastasis of muscle-diastasis recti (abdomen) 695.89 Intertrigo 278.1 Localized adiposity The patient needs: 15831 Excision excessive skin and subcuntaneous tissue (including lipectomy)abdomen(abdominoplasty) 49560 Repair initial incisional or ventral hernia, reducible The purpose of this letter is to request pre-authorization for this medically necessary procedure. Does this sound like a good letter? I called the ins company last wednesday and they tole me it had been sent to a doctor for review that the nurse there didnt make a decision so she sent it to a doctor. Is that a bad thing? Any info appreciated.

We greatly appreciate your interest in helping us build our Q&A database. To discourage vandals from posting garbage, however, we require people to register before posting.

You must be logged in to post an answer. Click here to log in.