Question:
How often and how long and many times do I need to see a Dr. to qualify for PS?
Please help!I am about to begin building a case for abdominoplasty and breastlift/reduction. In order to get insurance approval as medically necessary, for how long, how often and how many times do I need to get a Dr. to document and medicate a rash. Also does document mean Dr. writing in his patient notes and me taking pictures at home? Also please share any other things that might help me get approval. Thanks!!!! — Lynne C. (posted on July 28, 2004)
July 28, 2004
I am not positive but I thought it need to be over a long period of time.
(i.e.18 mths of unresolved treatments from different cremes and
medications. I just had ps done TT breast lift and liposuction and the
price wasn't to bad. $9000.00 for EVERYTHING(Dr, hosp,medication,pre-ad
labs & or time)!! And th results are out of this world!!! PS is
painful but absolutely worth it!! Good Luck!
— kelley G.
July 28, 2004
I am 18 months out, and started the ball rolling with the PS this past
February, at my 1 year anniversary. I had letter sent from my PS, (who also
took pictures), my WLS surgeon, my dermatologidt and my PCP. They all knew
and had in their records that I had the surgery, but there was no long term
documentation that I know of. I did ask the surgeon and PCP to document,
but the only thing that went into the external appeal (I was denied twice
and appealed to the State of NY), were the letters from the Drs and
pictures that my husband took at home, along with a detailed letter from
me, documenting the screw ups that the insurance company did. One comment
that was made by the reviewer, was that my pictures were not dated. If you
are going to use pictures as support, try to get them date stamped, or
somehow prove when they were taken. I was lucky that I was still approved
even without this info. I suppose every state and insutrance company is
slightly different. I am having my abdominoplasty on 8/17. Can't wait!!
— Fixnmyself
July 28, 2004
So much depends on your insurance company. I had so much extra skin on my
abdomen that the insurance company (BCBSIL) approved based on pictures
alone. I had seen my PCP for rashes, and had had two prescriptions filled
in the previous six months. I don't know if BCBS checked my claim records
for anything, but if so, that's all they would have found. The obvious
extreme deformity was enough convincing in my case. (I don't know exactly
how much skin was removed, but one surgeon estimated I had 10 to 12 pounds
of extra skin on my abdomen alone.) From what I've seen by others, the
sooner you start documenting, and the more documentation you have, the
better. The best documentation is notes in your medical records. I don't
know if home pictures help, but I have heard some say that home pictures
documenting a date taken were helpful to them.
— Vespa R.
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