disappointed...

I had my plastic surgery consult in August. I finally got some information from them yesterday. The insurance company requested photos (evidentally the doc's office doesn't send them unless requested) and they were never sent. I got a letter saying we requested additional information and never recieved it so you have to resubmit the approval application. I called the doc's office and THEY said it was a denial did I want to set up financing??? UHM??????? THEY wanted the freakin photos...they didn't deny me they wanted to SEE what kind of skin we are discussing here. Now it is December and my insurance is changing in January so the doc won't even do anything else to help me until THEN! When I get my new book I am going looking for another plastic surgeon. My sister had her 3rd round of plastics yesterday so that was bittersweet! She has had arms, tummy tuck x2, inner thighs and now outer thinhs, butt and back. She is considering breast lift. She had her plastics at the bariatric hospital so I spent a few minutes encouraging bypass patients while I was there! THAT was incredible! Chatting with people who were in that OH MY GO WHAT HAVE I DONE TO MYSELF??? stage! A few tears from others a few from me...GREAT way to end the day! hopefully I can be around more now that school is calming down! Nic 291/165/150

Nicole, there is still time for you to get very proactive; do you have copies of the photographs? If not, DEMAND them from your PS's office - don't wait for them to send them, go pick them up yourself. These photographs are part of your medical records so you are entitled to get copies of your entire file, including photographs. Once you have them in hand, PHONE your insurance company immediately and tell them you have the photographs, that your surgeon's office is not able to respond timely and that you will be sending them (or hand-carrying them is better) to the insurance company yourself. Either overnight mail the photos, or hand deliver them. If the determination is made before your insurance carrier changes over, they SHOULD cover it retroactively. As long as you get notification that it will be covered before the change, you will be covered. I am SO angry when I hear about these stories! PS offices are notarious for being very passive about trying to assist their patients in getting insurance coverage. They perpetrate the terrible scenario that for us, this work is merely cosmetic. This is so far from the truth! The fact is, living with the devestating effects of excessive redundant skin after significant weight loss is every bit as harmful in terms of physical and mental health as being severly obese. If you can convince your insurance company of medical necessity, you will be covered. I was VERY aggressive in pursuing coverage for all the work, even though my PS kept telling me none of it will be covered. Well, all of it has been and will be covered, including TT, abdominoplasty, breast lift (the best work I've had done so far, for the first time in my life I have beautiful breasts), and in January, brachioplasty (arm lift) lower body lift and thighplasty (thigh lift). I had to go through 2 appeals to get the lower body work covered, but they finally overturned the initial denial. Persistence is KEY. You must FIRST believe that you are ENTITLED to this coverage! Then, make it happen. I am SO angry about this! Good luck and keep us posted. Maureen

Maureen I am so upset by the whole thing. I am now to the point where I am going to call them and tell them I will be using another Plastic surgeon because of their inability to help me! Some one else can get my $$ and my word of mouth, I have 4 friends now that are looking into plastic surgery...I will not be recommending Dr.McAdoo. I have heard good things about another doc in town so I will try them! UGH!!!! I am really sad! My insurance company is in Michigan so I can't hand deliver anything. OK...4 weeks to new insu8rance and i am going to call Monday for a consult with the new guy! New year, newly proactive ME! Thanks for the encouragement! nic 291/161/150

Nic, You have every right to be ticked off, however, I agree with Rennie, keep fighting to see if you can get this done before the change. It is still possible that the new year can bring on better results. If not good luck with the new insurance company. Make sure you get those photos anyway, so you can use them for the next case. Maybe the new doc can get it done before year end. You never know. Marilyn, the Bearlady