Insurance denial/frustration

[LisaMarie65 2]

Hi all, new to this particular forum but hope to get some input....so I reached my goal but not done yet I was banded in 2009. I sought out cosmetic surgery, pannectomy, tt, breast lift with minimal reduction, arm lift. I have Aetna insurance I was denied, BUT today my surgeon had a "peer to peer" phone conference I am praying now for good news, none of the above procedures are for looks, they are necessity each one...has anyone experienced this has anyone been approved after the peer to peer conference?? I also have Medicare but can't seem to get any input on how they can help ... Any input from anyone would be greatly appreciated ... I am sad frustrated and feel near tears over all this Thanks in advance.

[DELETE THIS ACCOUNT! 12,703]

This is strictly my experience, I'm no expert.

It seems most insurance will cover a panniculectomy if it's medically necessary. They usually require the skin to hang below the pubic line, significant weight loss (100 pounds), and/or skin break down. Most will also cover a breast reduction (lift would be included) but not any sort of implants (unless it's because of cancer). Again, the company will have minimum requirements for this.

As far as Tummy Tuck and arm lift, it's highly unlikely you will get insurance to pay for either of them.

It also seems for insurance to cover any of it, they must be submitted and completed one procedure at a time and billed very carefully.

Again, I'm not an insurance expert but this seems to be the norm. I hope your doctor has luck persuading them to cover it.

Best wishes.

[John LoMonaco 1]

Insurance coverage is harder to get these days, and there are medical criteria that must be met. Each company has slightly different requirements but you need to know them so you can prepare your appeal in case you are denied. First-time approval for plastic surgery can happen if you submit the letter properly.

Check out this section of my website and click under the "Tips for Getting Insurance Coverage" article for links to some of the companies plus tips on going through the approval process:

http://drlomonaco.co...ient-resources/

Best

Dr LoMonaco

www.drlomonaco.com

www.bodylifthouston.com