California post op reconstructive so called plastics procedures denied.-a remedy.

Rockne
on 10/30/11 9:18 am - South Orange County, CA
For those of you who have been denied by your California based HMO insurer for needed reconstructive surgery, especially with “Kaiser," but others as well, feel free to contact me directly via my OH profile- contact mailing and I will direct you to a firm in Los Angeles which is pursuing the matter with the substantive change noted a few years back in the CA Health and Safety Code found, and well researched by my friend and renowned, esteemed Attorney, D. Cox.

Put simply, this change in the law suggest a showing of the common “medical necessity requirements" for any number of reconstructive procedures applied for and latter denied may no longer apply and could now be remedied by a simple resultant showing of abnormal structures post-op and your need to seek appropriate remedies via their efforts pursuing the matter for a large number of so aggrieved individuals. This very well respected and high profile firm invited me to post this without making this expressly public in contacting them.

I’m a tad overwhelmed with work demands now. (Almost always these days,) but will make every effort to get back to all in a timely way.
 
Rock    
(deactivated member)
on 10/30/11 3:39 pm - San Jose, CA
To follow up and elaborate on what Rock said - if
* you have EVER applied for and been denied coverage for reconstructive surgery to remove excess skin post-bariatric surgery
* by an insurance company in CA (especially Kaiser or other HMOs, but also a fully-funded PPO or POS plan),
* since July 1999,
* whether or not you ever followed up with an appeal,
* whether or not you ever self-paid for reconstructive surgery, and
* whether or not your are still currently insured by that insurance company,

this law firm may be able to help you get reimbursement for what should have been covered if your claim was improperly denied - especially if it was for lack of medical necessity.

If you are interested in this, send your email addy to Rock.  This will not only have to potential to help you, it could help others get access to coverage that is mandated by CA law more easily as well.
 
Rockne
on 10/31/11 1:09 am - South Orange County, CA
Thank you, Diana, for expounding on this and adding much needed clarity to my post(s). I’m going to take the liberty of crossing posting this to two other forums I posted in unless you have already done so.

Hope this finds you and Charles well.

In gratitude,

Rock
(deactivated member)
on 10/30/11 5:17 pm
(deactivated member)
on 11/1/11 1:43 am - Califreakinfornia , CA
Rockne
on 11/1/11 6:14 am - South Orange County, CA
Rgratefully, I don't know you but I appreciate the bump. **Smiling**

Rock
(deactivated member)
on 11/1/11 9:56 am - Califreakinfornia , CA
I just faxed a letter to Kaiser today regarding this. I'll let you know how it goes, or you can ask me how it went in about 15 days.
(deactivated member)
on 11/5/11 7:03 am - San Jose, CA
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