Question:
HERE IS HOW I GOT APPROVED FOR RECONSTRUCTIVE SURGERY

<center>I have been approved by Independence Blue Cross and had the following procedures performed August 13, 2003: Tummy Tuck (Abdominoplasty w/ muscle tightening)Cpt Code: 15831 Bilateral Thigh lift -Inner (Bilateral Thighplasty - Medial)Cpt Code: 15832-50. I won my appeal with Independence Blue Cross September 30, 2003 and will be having the following surgeries performed in December 2003. Bilateral Arm lift (Bilateral Brachioplasty)Cpt Code: 15836-50 Bilateral Breast lift (Bilateral Mastopexy -bilateral)Cpt Code: 19316-50 Bilateral Hip Lift Cpt Code:15834-50 <center>MY BRILLIANT AND TALANTED SURGEON<center> Dr. Patrick Pownell 7150 Greenville Ave Suite 310 Dallas, TX 75231 214-368-3223 voice 214-368-3177 fax Surgeries will be @ Presbyterian Hospital in Dallas <center>HOW TO GET RECONSTRUCTIVE SURGERY APPROVED AFTER WLS</center> 1. Takes pictures of every rash, sore, bump, mark, cut and infection you get as a post-op anywhere on your body - you never know where you might want to get skin removed, and mark the pic with the date and how many months post-op and pounds lost. 2. Call your PCP every time you get a rash, sore, bump, mark or infection and ask them to prescribe a cream for you - mine always prescribed medications I had to get filled at Walgreens keep your receipts and labels in preparation for your letter (see #3) 3. Tell your PCP NOW that when you approach your goal weight, you will be asking them for a letter of medical necessity for skin removal procedures, and ask your doctor to document every complaint you have about skin disorders, back pain,neck pain, shoulder pain, joint soreness and the like - it will help them write a more complelling letter a year down the road. 4. Take your own photos of hanging skin every 3-6 months, date them, list months out, pounds lost, and any problems the skin is causing. 5. When you go to your post-op visits with your wls surgeon,Ob-Gyn,Chiropractor, Physical Therapist tell them of your skin problems, back/neck/shoulder/joint pain, and tell them you may be asking them for a letter of medical necessity when it comes time to remove skin so they can start documenting now (my WLS surgeon had one ready in case the PCP letter didn't get me an approval). 6. Learn the vocabulary and school the insurance person at the Plastic Surgeon's office in case they don't know - if you are not confident, ask them to let you review the request before it is submitted to insurance. Things to know: plastic surgery is never covered by insurance, reconstructive surgery often is. Elective procedures are never covered by insurance, so make sure yours is listed as medically necessary. 7. For you writers, when you journal, highlight the section where you talk about how your loose skin is starting to affect your quality of life, just in case you have to write an appeal letter later, you can look back on these notes to help you draft it. 8. Never take no for an answer. Read your insurance policy and tear it apart and get a full understanding of what they need for documentation. You should have all of your documentation to show you have the need for surgery so use it. Do not count on your surgeon to do it all.They have other patients besides you and sometimes get sidetracked. Who knows your issues better than you. Before they send your insurance your letter please read it as many surgeons to not include the neccessary info as they hate dealing with insurance and they prefer you to pay cash. When they accept insurance they have to take less cash. Be your own advocate and read yur letter before it is sent to be sure the things the insurance company care about are covered. 9. Insurance companies do not not care that you have issues fitting into clothes and have to buy larger sizes or that your appearance is disfigured. They care about rashes, infections, back, neck, and shoudler pain, body odor, medications you have used to get rashes and infections treated, and the amount of time you attempted to treat the problems. Most insurance companies require 3-6 months of documentation. Save everything. 10. Document everything. Send it to them yourself and keep the originals as they always have a habit of loosing pertinent information. The main thing is to never give up. Do your research and be armed. Never let your emotions get to you during a hearing or appeal. They do not care about tears. Stick with the medical information. They are money hungry and try to save every cent even if it means you suffer because of their thriftyness. <center>P.S. I know how it works take my word for it. I got all of my surgeries approved because of my tips above. I will warn you though, some insurance companies have exclusions on reconstructive/cosmetic surgeries period and nothing will work no matter what type of functional impairments you have. I had United Healthcare -EPO my first round and nothing worked. I switched to Independence Blue Cross July 2003 during open enrollment and hit the jackpot. They rock. Good Luck and God Bless.</center> — Teena A. (posted on October 3, 2003)

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October 3, 2003
TEENA, YOU ARE THE MOST AMAZING WOMAN AND SO GENEROUS OF SPIRIT. THANK YOU FOR SHARING THIS VITAL INFORMATION. I AM FILING IT AWAY. HOPEFULLY, 150 POUNDS FROM NOW I WILL BE ABLE TO FOLLOW IN YOUR FOOTSTEPS RIGHT INTO DR POWNELL'S SKILL ARMS. YOU ARE AN ANGEL. Ann in TX
— Ann B.

October 3, 2003
Teena..you are something else, girl!! This is so good of you to share. I wouldn't have thought about a lot of this stuff. THANKS SO MUCH...Open your arms cuz there are hugs coming your way...MJ
— Mary Jane C.

October 3, 2003
Tina thank you so much for being so informative. I am printing all of your responses to file for future use. Thanks for giving me the information I will need to have some "skin" removed!
— Susan B.

October 3, 2003
Teena, WOW!! Thanks for the information. I, too, have printed it off for future reference. I have already been to the doctor v=for back pain. Never thought about metioning that I will be seeking skin removal in the future. Also the pictures- that is a great idea. Thank you so much for sharing your knowledge with us all.
— Jan S.

October 3, 2003
YOU GO GIRL!!! You have BEEN ON THE BALL!!! You will be helping me and countless others in YRS TO COME with your graciousness and generosity in sharing this important info. THANK YOU! THANK YOU!! THANK YOU!!! I'll be filing this away for when needed, and I haven't even been approved for surgery yet. This will make it soooo much easier when I need/want to have these improvements made to my body.
— bufordslipstick

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