letter of necessity from physician

mariecarmen · June 23, 2007

I had my consult with the plastic surgeon yesterday and he explained everything to me. Now the only thing to do is get insurance approval. The surgical coordinator asked me to get letters from my primary and lapband doctors explaining the need for the panniculectomy.< /p>

Anyone go through this before and have a good letter to share? When I was going for lapband approval, the surgeon's office gave me a sample letter for my primary to complete and sign. I was approved in 2 days.

I only hope this approval goes nearly as smoothly.

If not a whole letter, what else should be included besides rash history?

Thanks in advance.

MC

Chickie · June 23, 2007

I live in Australia, so it is a little different, but I had to get a referal from my GP to the reconstructive surgeon. It really wasn't a huge deal, because I did need the surgery.

I hope all goes well for you.

GayleTX · July 18, 2007

They need to use the term 'reconstructive surgery' not cosmetic. Pictures are very important. My approval was based on back aches and balance problems due to a heavy pannus. I had no history of rashes, etc.

mariecarmen · July 18, 2007

The letter did the trick!

I read through all the reasons people here were approved. Since I had most of the symptoms described but hadn't considered that the cause could possibly be the large pannus, I included them.

I've been approved and now look forward to gazing down at the top of my thighs. I think the last time I saw them from that angle was in high school.

Wish me luck!

MC

GayleTX · July 18, 2007

Congratulations! yes, it's fun to look down and see your legs! I have a lap!! I do believe my PS also did a mons lift....I can see something else down there that hasn't seen the light of day in many a year!!

Hope you get your surgery soon.

vallin · July 18, 2007

:help:Gale I live in DFW area and have the option of using Dr. Benavidas, but i read previously he does not due post op care is that true ,, what insurance do you have and what Dr removed your pani? Please help.

GayleTX · July 18, 2007

Dr. B will se you after wls anytime you need help, but he does not do fills in his office.....they do his fills where he does most of his surgeries - a few blocks down from his office at the SCOR - Surgical Center of Richardson. His associate, Dr. Felts does them. However, I don't go there.....I go to Dr. Maese because he does them for me for just a co-pay on my insurance ($25) and at the SCOR it would be $84. Your situation may be different, however. I did have an EGD done at SCOR recently and they were all very nice and efficient. I have BCBS-TX thru TXU.

Dr. Todd Pollock removed my pani........the nurses at the hospital couldn't say enough good things about him and how good he was and how much better his patients do than most other PS's. His father is also a PS, Dr. Harlan Pollock. I've done very well, no drain tubes, no problems so far. They use the TX Institute of Surgery on Greenville around the corner from Presbyterian Hospt on Walnut Hill. Todd has an office in Allen, too, and that's where I see him. TX Inst. is a wonderful place....like a Hilton Hotel, state of the art.

lsprin · August 14, 2007

I so happy for you and hope that your surgery goes well for you. But could you please share or post a example of the letter that you submitted to you insurance company.

certifiedcoder · August 16, 2007

I am currently waiting for authorization myself but I think the key areas that should be included are:

1. The rash, and hygene issues. Any other issues, back pain, im balance etc....

2. weight loss amount. ( I hear they look for 100 + lb)

3. how long ago the surgery was and how long you have been maintaining the current weight loss.

I hope this help, heck I hope it helps me too! I am desperate to get rid of this ugly fat & skin that feels it has a permanent place - on my lap-everytime I sit down!