Question:
What's the process of appeals for Panniculectomy? United HealthCare POS (california )

I have United HelathCare POS California SBC. And I've been denied once so far on the panni. I'm on my Second appeal. The UHC says that SBC says that a panni, even after over 100 lbs is cosmetic, I had letters from my Primary abd my surgeon stating different. Also I have a double hernia. If I get denied agian my Doc sais my next step would be to appela to an outside appeals place maybe even to the state level. What can i do to get prepared for this? PLease any help will be greatly apprecaited!!!    — Tammy S. (posted on February 16, 2004)

February 16, 2004
I don't have an answer, but I would definitely be interested in hearing anyone else who has successfully appealed on this issue. I also have a hernia and want to have the body lift, but my PS has little hopes of it being approved.
   — Tparker

February 17, 2004
I HAVE HEARD OF PEOPLE GETTING THE TT AT THE SAME TIME AS THE TUMMY TUCK. THE ONLY THING IS I DON'T KNOW IF IT WAS UNITED HEALTH CARE. THAT IS THE SAME INSURANCE I HAVE THROUGH SBC, BUT I HAVE NOT HAD THE SURGERY JUST YET. CAROL BOOSER
   — CDBOOSER

April 18, 2005
I hate to discourage you so early on in the appeals process, but after going through 1 1/2 years of appeals, denials, pictures, you name it, I finally went ahead with hernia repair/panniculectomy on April 8, 2005 at an independently run surgery center in Columbus. UHC will pay the hernia surgeon's fee, the anesthesiologist and the facillty fee. If I end up paying for everything, the cost will not exceed $6,000, but the worst-case scenario as far as I can see, will be that I will pay $2,200 for the panni surgeon, who removed 11 pounds of skin that caused me countless yeast infections every summer. These surgery centers are not affilliated with a hospital, they are strictly outpatient facilities, and that is why the cost is reasonable. They do demand all costs be paid up front (2 weeks in advance of surgery). I had a totally positive experience and already I look fantastic. The two drain tubes were taken out 6 days after surgery, and I will see the surgeon for one more follow-up on Tues. Spare your aggravation and check into your alternatives-UHC won't budge an ince on panniculectomies. I bared my sould to them, and all I got in return was denials. People with our problems don't matter to the insurance companies. Good luck. rosie
   — rosemary H.

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