Oxford Freedom and apanniculectomy approval?

[Jenna12566 0]

I called and got the information so I can move forward with the consult (the plastic surgeon). Anyone have Oxford that was approved for the panniculectomy?

My insurance company said it's a case-by-case thing and if the dr's feel it's medically necessary they just get a pre-auth.

[Sue Magoo 71]

Good luck! If you have a history of rashes or other issues related to the excess skin and have them documented (or even photographed) it might help.

I wish you well.

Sue

[Jenna12566 0]

Thanks Sue,

I've heard pretty good things about Oxford so I'm hoping it goes okay.

Jen

[hungry4help 0]

Did Oxford approve your procedure? I've got Oxford Freedom too and getting approved for my band took just a couple of weeks. Since then, I've checked and it looks like they cover abdominoplasty pretty readily. Am curious to know what your experience has been.

Thanks in advance for sharing your story.

[Jenna12566 0]

I actually have an appointment this Thursday, 1/14/10. I have my progress notes, and two letters (one from primary and one from surgeon).

I called the insurance company to see if they had certain criteria, but they said it is per individual. The outlook is good so I'm staying positive. I will let you know. Good luck with your journey!

Jen :smile2:

[hungry4help 0]

That's great, Jenna. Good luck with your appointment. Would love to hear how it goes.

BTW: am sure you've already seen this, but thought it might be useful to anyone else out there who has Oxford Freedom.

https://www.oxhp.com/secure/policy/abdominoplasty_1008.html

[Jenna12566 0]

I actually did not see that. Thank you so much! I have all of that so it looks better than I thought.

I will let you know what happens.

Jen

[hungry4help 0]

Hi Jenna... just checking to see how your consult went. I hope it was all good news.

[Jenna12566 0]

Thanks so much for checking in.

The consult went very well. The doc was great and answered all of my questions. He was going to put everything together and send it out to the insurance company this week so hopefully within the next couple of weeks I will have an answer. He was pretty optimistic.

He also did a breast lift consult. About 15 years ago I had a breast reduction and now that I've lost the weight......well you know lol. Besides the sad, droopy look I have a lot of scar tissue. It's also nice to know that if I do get approved he will fix my port site. I have a pretty decent sized lump on my stomach due to scar tissue from that so he said he can fix that.

Until then my fingers are crossed.

[hungry4help 0]

glad to hear it went well. please keep us posted.

have they calculated what your out of pocket expenses will be?

[hungry4help 0]

Jenna: just checking to see how your dealings with Oxford have gone. Any luck? Have they stated what your out of pocket expenses will be? What's the cost of your surgery?

Anyone else out there, please feel free to chime in.

I had my first consult earlier this week and the plastic surgeon suggested a full lower body lift. Total fees will be in the neighborhood of $17k; i live in Manhattan and his office is on Park Ave. Yikes. Will need to see a dermatologist to verify rashes etc, a medical photographer to document the sorry state of my skin, and get letters from my primary care physician and bariatric surgeon. All seems doable and I'm hoping to have the procedure done in late November.