Insurance Question ?????

This is how my Cingna insurance reads for requirement:

 

 

Pannus causes a chronic and persistent skin condition (e.g., intertriginous dermatitis, panniculitis, cellulitis or skin ulcerations) that is refractory to at least six months of medical treatment. In addition to good hygiene practices, treatment should include topical antifungals, topical and/or systemic corticosteroids, and/or local or systemic antibiotics.


Does this mean I have to go to my PCP for 6 consecutive months? Or would a few times during a 6 month period be enough?  Im just afraid I want have anything to show  my Dr. EVERY month.

Did anyone else get approved with this requirement? How did you do it?  I would appreciate any advice.
 

It means you must  be having one of the mentioned issues, see your PCP, get treatment - stay on the meds, creams,etc. while having the required hygiene.  If after 6 months of treatment the condition has not improved or resolved -  you may be eligible for coverage.

For instance - you have a skin fungus, yuk smell, etc.  You stay on treatment and make regular visits to your PCP.  You do everything they prescribe and 6 months later the fungus isn't any better.  The PCP can write that info to insurance.  Insurance may or may not approve a pannulectomy - most insurances will only pay for skin removal - not a tummy tuck or abdominoplasty.

Hope that helps.

That is how most insurances work, they will not pay for cosmetic surgeries unless it is a life threatening thing or hinders movement. Most insurance companies will not grant the cosmetic procedure unless you have tried other things first. Have you heard of lifestyle lift? I wish you luck!

I was origianlly denied after seeing JUST my PCP for intertrigo for 3 months.  I saw her once a month and filled the RX's regularly.  She wrote a GREAT letter but I was denied because my ins co wanted a "specialist" to treat me.  I then saw a derm 2 x in 2 months, he wrote them and the denial was finally approved.  I suggest you contact Cigna and ask if they require a "specialist" or is your regular PCP ok to treat, document and write letter.  ALSO...  send ins co copies of copays, rx's, and any OTC treatments recpts.  The more documentation the better.  Just call ins co and verify that you do not need to see a specialist!!!  I wasted 3 months being treated just by my PCP (altho she treated the same as a Derm), but the ins co insisted on specialist!
Good Luck!!
Jane

Mine had a 3 month requirement. I documented the rashes with photos on the same days as I went to the PCP.  Mine were actually spread out over more than three months.  In my appeal letter I stated that my PCP visits were spaced out because I used OTC powder and sample tubes of creams from my PCP to control the rashes between office visits.

They reversed their decision and I am approved for a Panni removal and having it done next week!  :)