Question:
Initial letter to ins. co. requesting approval for reconstructive surgery?

Would you please share any letters written from you or your PCP to your insurance co. requesting authorization to see a surgeon for abdominoplasty, panni removal, breast lift and arm lift? Did you send pictures? SO much appreciated. Email is [email protected].    — Vicki S. (posted on July 25, 2003)

July 25, 2003
You do know that you cannot request approval for this surgery. You plastic surgeon is the one who submits letter to the insurance company for an approval because he/she has to submit the proper procedure codes. And yes, it's almost a must that you send photos, and there again your plastic surgeon will submit photos. If your PCP has treated your or referred to your treatment for rashes, back pain, sleep disorder, etc. then it's a good idea to have the PCP and anyother docotor submit a letter explaining what you are being treated for and how it was treated. I also sent my personal letter explaining how my life has been living with this hanging skin. The key to getting approved is proving MEDICALLY NECESSARY. I know this all how.....because I've through all this. I had my full addominoplasty (TT) on July 8th and my insurance company covered 100% AFTER I appealed. If you would like copy's of my letter just email me at [email protected].
   — Jeanette D.

July 25, 2003
I do agree with the previous poster to a degree. However, you can initiate the process yourself. I had letters documenting rashes, infections, back, neck, shoulder pain, problems walking and etc. from all of my doctors and I had my sister take my pictures nude and sent in my own letter and medication recipts before I even had my surgeon do his letter and I was approved rather quickly and on my first try with my new insurance for tummy tuck and thigh lift. See my profile if you want tips on what insurance companies want to hear regarding approving reconstructive surgery. Yes, your surgeon has to put everything in to the insurance company, but I opened my own case because I already knew what procedure codes were and I was on a time crunch. Be proactive and help yourself because no one cares more about you than you. Waiting on your surgeon will take time and if you have time cool, but I did not. Good Luck.
   — Teena A.

July 25, 2003
Tenna, What procedures did you have done after your weightloss? Most people don't know the proper codes to submit to the insurance company, so GREAT JOB! Is there a list (or website) of procedure codes that you can give to everyone in the case they would like to submit their OWN leter to the insurance company like you did? Thanks for your input!!
   — Jeanette D.

July 25, 2003
If you go to my profile and then my personal website listed at the top of my profile in the left hand corner you can see all the codes listed on the reconstructive surgery link on my site. I knew the codes because I researched them. I was approved for TT and Thigh lift July 16, 2003 and my surgery is August 13th, 2003. I even have a sample of my letter I wrote to insurance company on my site to view. Good Luck.
   — Teena A.