Marcy Palmeri

Medicare & Panniculectomy Marcy Palmeri Panniculectomy & Medicare: How to get Medicare to cover it. Aug 14, 2015 75views 3Likes LinkedIn Panniculectomy Medicare Notes Marcy Palmeri Medicare does not give prior authorization for any surgery. They require that all surgery performed be deemed medically necessary. Medicare decides whether or not the surgery performed was medically necessary after you have the surgery and they view the operative report. You can help Medicare decide your surgery is medically necessary by providing them with as much documentation regarding your condition as possible. Many surgeons require that you pay upfront since there’s no guarantees that they will get reimbursed. KEEP A PANNI JOURNAL *Your weight must be stable for at least one year following your gastric bypass. You cannot lose or gain weight; your weight must be stable. Meaning: Document in your journal the dates you weigh yourself and your weight. Weight at the same time each day, in the buff. The morning after peeing and before coffee, water, food. *You must show that you have tried conservative treatment for the rashes in your skin folds. You must have had your rashes treated by a physician with prescription creams or ointments for at least 3 months and still have no relief of the rash symptoms. Meaning: YOU: Keep a journal complete with dates and photographs of the type of treatments you’ve tried: Corn Starch, A&D Ointment, Diaper Ointment, Herbal Remedies, etc. complete with dates and photos. Panniculectomy Medicare Notes PCP: Make an appointment 3 months or more in a row and sporadically after that and document it in your journal. Show him the rash and tell him what you’ve been doing to rectify the situation. Ask him to prescribe cream. The cream will not work on most of these rashes or yeast infections because the flap of skin will consistently recreate these rashes. But, you are showing that at least you’re trying. Bring rash photos with you to PCP appointments and make copies for his file. Ask him for a Recommendation for a surgeon. Keep ALL records in your Panniculectomy Journal. I can’t stress this enough. This is your key to a possible surgery. *Write a letter to Medicare about how your abdominal pannus affects your daily living. Meaning: Does it stop you from… Exercising? Running? Jumping? *Does it cause you pain in any way at all? (perhaps when turning over in bed, showering, everyday life in some way?) *Do you trip or fall because of your pannus? *Is there a foul odor that may lead to an infection? Your abdominal pannus must hang to the level of your pubis. Medicare does not pay for abdominoplasty: TUMMY TUCK- tightening up the abdominal muscles and replacing your belly button. They only pay for a panniculectomy: removal of apron of skin. It’s from under the belly button down to the pubic area. Precise documentation will assist you in getting your Panni covered. Words of Wisdom: You can also get a recommendation from a Psychiatrist if you are seeing on for Depression or various other Doctors if the weight from your Pannis is pressing down on your internal organs which is causing pain, discomfort or serious ailments. Investigate. Get as many recommendations as possible….including one from yourself. Shop around: Some surgeons DON’T require you pay UPFRONT prior to the surgery. Some of them actually bill Medicare. It’s not easy to find, but diligence may pay off. Shop around. Seriously. APPEAL LETTER: If you are still denied, there’s always an appeal letter. There are free examples of that via a Google search. Very sincerely, Marcy Palmeri Marcy@WLSolutions.net Disclaimer: This is by no means a complete list of what a patient can or cannot do with regard to Medicare Panniculectomy coverage. There is absolutely no guarantee. These are merely my notes as it pertains to my personal experience. I am not a Doctor or a Lawyer.