Re: Lipo reimbursement

[Guest guest]

I had no luck obtaining reimbursement from my school district funded insurance plan administered by CA Blue Shield until I turned to my teachers union--Alhambra Teachers Association, a local of California Teachers Association (NEA).

Suddenly I had a benefits expert working on my behalf. I also received free legal guidance. The union President and Executive Director got enthusiatically involved and I ended up receiving 80% of the cost I paid for Silikon injections.

If you have a union, their services can prove to be invaluable. This was true for me.

Joe

Dennis, you wrote

"

My medical group reasons that the procedure that has been proposed (liposuction of the fat deposits and fat injection for the lipoatrophy) is considered cosmetic by Medicare and therefore is not covered. The letter from the Department of Managed Health Care is a memo dated March 14, 2002 and comes from Linares, M.D., Medical Advisor. According to the medical group, there was no followup direction since the letter and since Medicare hasn't recognized lipodystrophy treatment as reconstructive, it is not covered. The representative said that maybe if I were a commercial patient rather than a Medicare beneficiary, AB 1621 might apply. Since I am on Medicare, it doesn't. I tried contacting the contact person listed on the letter - Phillis Soresi, but the email address is no longer valid.

 

Does anyone have any further clarification or know what agency might have further information? I thought the passage of AB 1621 was supposed to cover this treatment, particularly in light of the letter from the DMHC. Silly me."

 

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Your doctor's mistake was a simple one. Unless you specify PAIN, SLEEP APNEA, FATIGUE, and other clinical symptoms like that, you will not get reimbursement for lipo surgery of any kind. CA has a bill that supposedly makes it easier, but it did not seem to help you at all, I guess.

Can you appeal under Medicare with new information?

 

Regards,

Vergel

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