What are my chances of approval for panniculectomy appeal?

Question

I have a BMI of 33.93. Obesity Umbilical Hernia Peripheral vascular disease Chronic venous insufficiency Anemia Pre diabetic Sometimes rashes within my belly button and underneath. I have an appeal in place. Does anyone know with UHC Community Plan if it takes a few appeals to get the surgery approved?

J. Timothy Katzen, MD, FACS · Answer

Hi Honest783143 in Wausau, WI, 
Thank you for your question about your chances of approval for your panniculectomy appeal.  Thank you for your history.  Unfortunately, there is no universal set of criteria for panniculectomy approval.  Each medical insurance plan has its own criteria required for approving a panniculectomy.  Regarding the UHC Community Plan, pleasewhat are your chances of approval for panniculectomy appeal review its specific requirements for a panniculectomy.  Their requirements may be posted on the UHC Community Plan website.  Typically, for your insurance provider to authorize coverage and reimbursement for a panniculectomy, you must satisfy the following criteria: 1) Your abdominal pannus must extend below the level of the pubis or pelvic bone.  2) Ideally, your BMI should be 30 or less; however, the pannus may make this impossible.  3) If you have lost over 100 pounds by diet and exercise, you must maintain a stable weight for six months.  If you have lost over 100 pounds through weight loss surgery, your weight must remain stable for 18 months   4) A documented history at a medical facility of recurrent rashes or non-healing ulcers that do not respond to antibiotics, antifungals, or steroid creams is required, and 5) there must be documented evidence of ambulation difficulties or impairment with activities of daily life.   A panniculectomy conducted exclusively for the alleviation of low-back discomfort is deemed medically unnecessary and typically not insured.  Most plastic surgeons offer free virtual or in-office physical consultations.  Therefore, explore what other plastic surgeons have to say.  Good luck.  I hope I have answered your question about your chances of approval for the panniculectomy appeal.  If you have any more questions regarding the panniculectomy, extended lower body lift, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, contact an experienced plastic surgeon.  Since the panniculectomy or lower body lift is a major procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing these procedures.  Do your research.  Ensure they have performed at least 100 panniculectomies or circumferential lower-body lift surgeries, and have before-and-after photos to prove it.  Carefully examine their before-and-after pictures and check their reviews on RealSelf.   If you cannot find an experienced panniculectomy or lower-body lift surgeon in your neighborhood, consider traveling out of state if necessary. Sincerely, Dr. Katzen. (Plastic Surgeon, President of  the American Society of Bariatric Surgeons, certified by the American Board of Plastic surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

What are my chances of approval for panniculectomy appeal?

Answers (1)

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