How can a claim be denied based on photos and not a physical examination? PAH - CoolSculpting (Photos)

Question

Diagnosed with PAH after physicals exams by my coolsculpting provider a PA, and confirmed by a board certified plastic surgeon . Now undergoing lipo on bra-line, flanks and Abdominoplasty - at my expense. Was told by provider that Allergan's policy is to pay 100% corrective surgery if diagnosed with PAH but they are denying the claim saying its not consistent with PAH - of course. Inform your patients of the risks and the cost of corrective surgery.

Reps B. Sundin, MD · Answer

Sorry to hear that you may have PAH, the good news is it can be treated with liposuction.  In my experience Zeltiq paid for most of the claims I have seen, even ones that seemed not to be true PAH.  I I have seen 2 cases of what I deem true PAH, and its pretty undeniable.  In true PAH it appears as if you are growing an applicator on your body.   They may have denied you based on your photos, it is hard to fully see the spots in your before photos vs your after photos; some are taken with a shirt on.

Edward Stokes, MD · Answer

Thanks you for sharing this. I'm sorry to hear that you had an unsatisfactory experience with your provider. We have treated well over 20,000 cycles of CoolSculpting and have yet to see one actual case of PAH. CoolSculpting has proven itself to be a very safe and effective non-invasive treatment for the permanent removal of fat from the body. If you have been examined  by a board certified plastic surgeon and have been determined to have PAH, I would definitely resubmit your claim to Allergan. They have always assured us that they would come through and take care of 100% of the costs were any of our patients to present with PAH. Good luck with everything.

Joseph A. Eviatar, MD, FACS · Answer

We
are so sorry to hear about your experience but we appreciate that you took the
time and shared it with us.
It
has been our experience that PAH is a very low occurrence reaction to CoolSculpting.
It really is a non-invasive and effective procedure. Out of the many thousands
of treatments we have done, there have only been a couple of PAH incidents and
Allergan has acknowledged the claim and resolved correction. 
We
encourage you to resubmit your photos. It is critical that your photos are consistent.

We
wish you the best of luck and hope that you find resolution.

Grant Stevens, MD · Answer

Thanks for sharing your experience and sorry you have to go through all of this.  In the 10's of thousands of cycles we have done, we have only had a few and they have been taken care of without incident. It truly is a rare occurrence. You may try resubmitting your claim with some new photos.  Having consistent photos to compare is crucial. Coolsculpting really is a safe and effective procedure and any rare side effects can be addressed.  Best of luck

Lauren Chavez, MD · Answer

We have only seen one case of PAH, and, we used other, non-invasive ways to improve it. But, it is good to learn from your experiences (although, I am VERY sorry for YOUR experience!) Thank you for sharing!

How can a claim be denied based on photos and not a physical examination? PAH - CoolSculpting (Photos)

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Answer: PAH after treatment

Answer: PAH after treatment

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How can a claim be denied based on photos and not a physical examination? PAH - CoolSculpting (Photos)

Answers (6)

Answer: PAH after treatment

Answer: PAH after treatment

Answer: Wow - thank you for that feedback!

Answer: Wow - thank you for that feedback!

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Recommended reading

Everything you need to know about CoolSculpting

Our mission is to create a world where every investment in modern beauty is Worth It.