Question:
How often and how long and many times do I need to see a Dr. to qualify for PS?

Please help!I am about to begin building a case for abdominoplasty and breastlift/reduction. In order to get insurance approval as medically necessary, for how long, how often and how many times do I need to get a Dr. to document and medicate a rash. Also does document mean Dr. writing in his patient notes and me taking pictures at home? Also please share any other things that might help me get approval. Thanks!!!!    — Lynne C. (posted on July 28, 2004)

July 28, 2004
I am not positive but I thought it need to be over a long period of time. (i.e.18 mths of unresolved treatments from different cremes and medications. I just had ps done TT breast lift and liposuction and the price wasn't to bad. $9000.00 for EVERYTHING(Dr, hosp,medication,pre-ad labs & or time)!! And th results are out of this world!!! PS is painful but absolutely worth it!! Good Luck!
   — kelley G.

July 28, 2004
I am 18 months out, and started the ball rolling with the PS this past February, at my 1 year anniversary. I had letter sent from my PS, (who also took pictures), my WLS surgeon, my dermatologidt and my PCP. They all knew and had in their records that I had the surgery, but there was no long term documentation that I know of. I did ask the surgeon and PCP to document, but the only thing that went into the external appeal (I was denied twice and appealed to the State of NY), were the letters from the Drs and pictures that my husband took at home, along with a detailed letter from me, documenting the screw ups that the insurance company did. One comment that was made by the reviewer, was that my pictures were not dated. If you are going to use pictures as support, try to get them date stamped, or somehow prove when they were taken. I was lucky that I was still approved even without this info. I suppose every state and insutrance company is slightly different. I am having my abdominoplasty on 8/17. Can't wait!!
   — Fixnmyself

July 28, 2004
So much depends on your insurance company. I had so much extra skin on my abdomen that the insurance company (BCBSIL) approved based on pictures alone. I had seen my PCP for rashes, and had had two prescriptions filled in the previous six months. I don't know if BCBS checked my claim records for anything, but if so, that's all they would have found. The obvious extreme deformity was enough convincing in my case. (I don't know exactly how much skin was removed, but one surgeon estimated I had 10 to 12 pounds of extra skin on my abdomen alone.) From what I've seen by others, the sooner you start documenting, and the more documentation you have, the better. The best documentation is notes in your medical records. I don't know if home pictures help, but I have heard some say that home pictures documenting a date taken were helpful to them.
   — Vespa R.