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

Rockne
on 10/30/11 9:31 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    
Rockne
on 10/31/11 1:33 am - South Orange County, CA
For much needed clarification for those interested, I'm adding in a posting by the aforementioned esteemed Attorney, D. Cox, from the main forum in reply to mine.

Her appreciated elucidation in her reply to mine reads as follows: 

" 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."

I trust it will prove helpful to interested parties.

Rock

(deactivated member)
on 11/5/11 5:50 am - San Jose, CA
*BUMP*
Rockne
on 11/5/11 9:23 am, edited 11/5/11 9:49 am - South Orange County, CA
Bump, I mean really a bump?**Smirk**

Hmmm, I won a few contests doing that and a few other dance moves in the seventies during the disco craze. Do I dare admit that along with fact I miss some musical talent back then and wowing the uninitiated who even back then on the East coast looked puzzled with me walking away with trophies to music they could not well relate to. So much RAW fun and take no shame in admitting that even here in CA where that musical genre never took fully hold. Who knows, maybe I'll dust off my over priced dated dancing shoes and make another stab it one day.

Nevertheless, I appraciate the bump and sadly not a single reply to any of my post going forward here or elsewhere in re plastics.

Tis as said,

Rock
(deactivated member)
on 11/5/11 9:27 am - San Jose, CA
It's too bad, really - the post-ops who were denied and who could benefit from this usually wander away and won't read this.  And the pre-ops who could prepare their requests for coverage properly, using the statutory language, are missing an opportunity as well.
Rockne
on 11/5/11 9:44 am - South Orange County, CA
Agreed! When here or seen in other related forums in the past, I saw many denials seeking insurance solutions. HELLO... ?? Is anyone within these simple parameters paying attention? 

Rock
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