Please Insurence letter need for PS

[Guest guest]

I m in need of a letter written , I am uneducated to the " medical

indications " that others have experinced, so any letter you have

submitted to insud=rence company would be great. I have nothing

medical wron with the excess skin, other then looking like Dumbos

sister,,,,,,

HELp Please forwrd ANYTHING .....you might have ..to person email.I

appreciate it .

Dr Maxwell doesnt do a great job as to submitting the appropriate,

medically necessary, to my advantage (if you know what I mean)

THANKS

XOXO

Lori

[Guest guest]

I would also like a letter like this. Thanks, Pam Mathisen

> I m in need of a letter written , I am uneducated to the " medical

> indications " that others have experinced, so any letter you have

> submitted to insud=rence company would be great. I have nothing

> medical wron with the excess skin, other then looking like Dumbos

> sister,,,,,,

> HELp Please forwrd ANYTHING .....you might have ..to person email.I

> appreciate it .

> Dr Maxwell doesnt do a great job as to submitting the appropriate,

> medically necessary, to my advantage (if you know what I mean)

> THANKS

> XOXO

> Lori

[Guest guest]

Hello everyone seeking plastic surgery. I've been very lucky to have

my insurance cover both my breast reduction and tummy tuck. I just

had my TT 4 days ago and am still home recovering. There has been

alot of questions as to how to get these surgeries covered by

insurance. My plastic surgeon wrote to my insurance company

(HealthNow New York) and I was approved in 2 weeks. Here is the

content of those letters.

Abdominoplasty letter:

" ________ is a ___ year old woman who has undergone a gastric

stapling and has lost a total of ____lbs. to date. Her current weight

is ____lbs. She plans on losing an additional _____lbs. With her

weight loss, however, she has developed a significant abdominal

panniculus with intertrigo being a constant problem, especially in

the warm months. She routinely requires anti-fungals in order to keep

this under control.

" On physical exam, she has no evidence of intertrigo at this time.

She does, however, have a significant pannus with a lot of redundant

skin, as well as significant diastasis rectus. I believe the best

treatment for this would be abdominal lipectomy and correction of the

diastasis rectus through a low transverse incision in order to reduce

the risk of intertrigo, as well as offer her additional abdominal

support and strength with the tightening of the rectus muscles so

that she may fully participate in her current exercise program.

" ICD-9

278.1 - localized adiposity

701.8 - skin laxity

728.84 - diastasis rectus

" CPT

15831 - excision excessive skin abdomen $3,800

" If this service is covered by the patient's insurance company, a

written predetermination of the amount allowed, deductible, and co-

payment would help the patient better understand her insurance

coverage and financial obligation. We will wait scheduling this

patient for surgery until we hear from you. "

Mammoplasty letter:

" ____________ is a __ year-old woman who has had difficulty with

macromastia all her life. She currently wears a DD brassiere but

finds that this is too small for her. She has undergone laparoscopic

gastric stapling with a weight loss of ____lbs. Her current weight is

____lbs. She wishes to lose an additional ____lbs. She is involved in

a significant exercise program and finds that her macromastia limits

her ability to fully participate in this. Past medical history is

significant for gastric stapling. Past surgical history is

significant for lumpectomy of left breast for benign mass. Family

medical history is significant for maternal great-aunt and first

cousin having breast cancer. Symptomology related to her macromastia

includes the fact that she has severe neck pain which radiates to the

base of her skull and back pain between her scapulae for which she

sees a chiropractor. She develops intertrigo between and beneath her

breasts, especially in the summertime. She routinely requires anti-

fungals in order to keep this under control.

" On physical exam, she is found to be _____ tall weighing _____lbs.

She has pendulous breasts with loose skin. I believe she would

benefit from bilateral LeJour mammoplasty with an estimate of

____gram removal on the right and _____gram removal on the left.

" ICD-9

611.1 - Breast pain

724.2 - Back pain

723.1 - Neck pain

695.89 - Intertrigo

" CPT

19318-50 - Bilateral reduction mammoplasty $7,000.00

19318-80 - Assistant surgeon 1,750.00

--------

$8,750.00

" If this service is covered by the patient's insurance company, a

written predetermination of the amount allowed, deductible, and co-

payment would help the patient better understand her insurance

coverage and financial obligation. We will wait scheduling this

patient for surgery until we hear from you. "

NOTE:

The mammoplasty estimated (and billed at) $8,750 was paid by

insurance at a " network-negotiated rate " of $3,180. The

abdominoplasty estimated at $3,800 has not yet been billed.

I hope that this helps anyone trying to get insurance coverage. Good

luck.

-Toni Lieb

MGB 5/31/00

296/176

[Guest guest]

Thanks, Toni, for posting these letters...I copied them off for

future use. I'm impressed that you are posting to us 4 days

post-op...hope that means you are doing well.

> Hello everyone seeking plastic surgery. I've been very lucky to

have

> my insurance cover both my breast reduction and tummy tuck. I

just

> had my TT 4 days ago and am still home recovering. There

has been

> alot of questions as to how to get these surgeries covered by

> insurance. My plastic surgeon wrote to my insurance company

> (HealthNow New York) and I was approved in 2 weeks. Here is

the

> content of those letters.

>

> Abdominoplasty letter:

> " ________ is a ___ year old woman who has undergone a

gastric

> stapling and has lost a total of ____lbs. to date. Her current

weight

> is ____lbs. She plans on losing an additional _____lbs. With

her

> weight loss, however, she has developed a significant

abdominal

> panniculus with intertrigo being a constant problem, especially

in

> the warm months. She routinely requires anti-fungals in order

to keep

> this under control.

>

> " On physical exam, she has no evidence of intertrigo at this

time.

> She does, however, have a significant pannus with a lot of

redundant

> skin, as well as significant diastasis rectus. I believe the best

> treatment for this would be abdominal lipectomy and correction

of the

> diastasis rectus through a low transverse incision in order to

reduce

> the risk of intertrigo, as well as offer her additional abdominal

> support and strength with the tightening of the rectus muscles

so

> that she may fully participate in her current exercise program.

>

> " ICD-9

> 278.1 - localized adiposity

> 701.8 - skin laxity

> 728.84 - diastasis rectus

>

> " CPT

> 15831 - excision excessive skin abdomen $3,800

>

> " If this service is covered by the patient's insurance company, a

> written predetermination of the amount allowed, deductible,

and co-

> payment would help the patient better understand her

insurance

> coverage and financial obligation. We will wait scheduling this

> patient for surgery until we hear from you. "

>

>

> Mammoplasty letter:

> " ____________ is a __ year-old woman who has had difficulty

with

> macromastia all her life. She currently wears a DD brassiere

but

> finds that this is too small for her. She has undergone

laparoscopic

> gastric stapling with a weight loss of ____lbs. Her current

weight is

> ____lbs. She wishes to lose an additional ____lbs. She is

involved in

> a significant exercise program and finds that her macromastia

limits

> her ability to fully participate in this. Past medical history is

> significant for gastric stapling. Past surgical history is

> significant for lumpectomy of left breast for benign mass.

Family

> medical history is significant for maternal great-aunt and first

> cousin having breast cancer. Symptomology related to her

macromastia

> includes the fact that she has severe neck pain which radiates

to the

> base of her skull and back pain between her scapulae for

which she

> sees a chiropractor. She develops intertrigo between and

beneath her

> breasts, especially in the summertime. She routinely requires

anti-

> fungals in order to keep this under control.

>

> " On physical exam, she is found to be _____ tall weighing

_____lbs.

> She has pendulous breasts with loose skin. I believe she

would

> benefit from bilateral LeJour mammoplasty with an estimate of

> ____gram removal on the right and _____gram removal on the

left.

>

> " ICD-9

> 611.1 - Breast pain

> 724.2 - Back pain

> 723.1 - Neck pain

> 695.89 - Intertrigo

>

> " CPT

> 19318-50 - Bilateral reduction mammoplasty $7,000.00

> 19318-80 - Assistant surgeon 1,750.00

> --------

> $8,750.00

>

> " If this service is covered by the patient's insurance company, a

> written predetermination of the amount allowed, deductible,

and co-

> payment would help the patient better understand her

insurance

> coverage and financial obligation. We will wait scheduling this

> patient for surgery until we hear from you. "

>

>

> NOTE:

> The mammoplasty estimated (and billed at) $8,750 was paid

by

> insurance at a " network-negotiated rate " of $3,180. The

> abdominoplasty estimated at $3,800 has not yet been billed.

>

> I hope that this helps anyone trying to get insurance coverage.

Good

> luck.

>

> -Toni Lieb

> MGB 5/31/00

> 296/176