Question:
Insurance approval for a pannilectomy ?
Anyone gotten your insurance company to approve a pannilectomy? I'm still early in my WLS journey (post op -60) but it took an entire year to get approved for WLS so I'd like to do my homework early for the reconstructive surgery. If anyone has sample letters to insurance or from doctors to the insurance companies I would be in your debt! :) — lilmskitty (posted on June 9, 2002)
June 9, 2002
I have Blue Cross of CA PPO
my reconstruction ( TT ) approval took
3 days and the grossest letter and a pic from my Doctor
it is all in how the Doctor writes it up
You will need a weight loss surgery Friendly Plastic Surgeon and a
Hernia...
Kathy
— Kathleen M.
June 9, 2002
hi, not to contradict another post here, but I remember reading someone who
was approved because the area were the skin hung, was cracked, chapped and
red.The area was affected because the skin rubbed togather creating a
rash,not unlike approvals for breast reduction when a person has alot of
rashes and dermatology problems under the breast. One thing that I would
agree with the other post is that you need to get a surgeon who is wls
friendly,,,they will look for more medical problems, to give to your
insurence,good luck,,
— amy T.
June 9, 2002
I had a TT the day after Thanksgiving last year. It had been 16 months and
122 pounds since WLS. The first time that I got a yeast infection from
the skin rubbing (in my belly button of all places) my doctor prescribed a
cream and told met that I didn't have to come in the next time I got one,
but to call and have him document it because it would make it easier to get
approved for the TT when the time came. I also had back pain from it and
an umbilical hernia. No problem getting approved.
— livnliter
June 9, 2002
I had my TT 2 months ago. It took several tries for my insurance,
Mailhandlers, to approve my surgery, but they did. Both my weight loss
surgery surgeon & my plastic surgeon wrote letters to the ins co. I
think it was the letter from the WLS doctor that did the trick; he had had
much more contact with me, more chart notes, etc. Anyway, I was approved
after the letter from him. The plastic surgeon had to write two &
possibly three letters before I was approved. I researched thru the library
a lot before I requested the TT & I did find a lot of good info there.
— Kathy W.
June 15, 2002
I had a panniculectomy and armlift last November. My secondary insurance
approved the surgery immediately - no questions asked, but my primary
denied the surgery requiring me to appeal their decision. My plastic
surgeon had already submitted pictures with his letter of medical
necessity, but I re-submitted copies of those pictures in the packet of
information that I sent to the appeals committee. Also included in that
packet were letters of medical necessity from my PCP, my bariatric surgeon,
my own personal letter of appeal, and a copy of the 1996 Position Paper
from the American Society of Plastic Surgeons entitled "Treatment of
Skin Redundancy Following Massive Weight Loss". A copy of this paper
can be obtained from www.plasticsurgery.org/profinfo/pospap/skin.htm. My
primary insurance provider approved the surgery within one week of
reviewing this information....including the armlift, which is almost never
covered by insurance. I wish you the same good luck!
— Diana T.
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