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*Treatment results may vary
Tummy Tuck - 1 year later
This was one of the best decisions I’ve made, medically. Dr. Shoen is great and he has done a wonderful job. I’m so pleased with the results.
35 yr. old mother of 2 via c-section with WLS getting a much needed panniculectomy and tummy tuck with liposuction
I chose Dr. Shoen (Plastic and Reconstructive Surgery Associates, L.L.C. Metchen and Monroe Township, New Jersey) as he was not just looking to immediately schedule me for surgery, has over 20 years of experience, has various awards and is a clinical assistant professor of surgery at UMDNJ and he was an in-network Aetna provider. I interviewed other surgeons and they wanted me to book my surgery that day and did not ask me about my Factor V Leiden (genetic blood clotting disorder) and if my hematologist approved of my requested surgery. I felt that Dr. Shoen wanted the best outcome for my surgical needs and provided me with realistic expectations for my procedure. He also was on other boards with my hematologist and was going to see him the day after my consultation. My hematologist also spoke highly of Dr. Shoen when I was getting my letter of medical clearance.
Also, the other surgical coordinators and surgeons told me that Aetna NEVER approves panniculectomy claims so that they would not even try to submit one on my behalf. It took a little coaxing on my part, but Dr. Shoen's office submitted my claim and I was approved by Aetna for coverage of my panniculectomy on my first submission. Dr. Shoen's office submitted pictures of my extremely loose and low hanging skin (below pubis) and subsequent rash caused by the skin fold irritation. Please note that the code for panniculectomy, 15830, asks for the following:
Panniculus hangs below level of pubis, documented by photographs; and
The medical records document that the panniculus causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs over 3 months while receiving appropriate medical therapy (e.g., oral or topical prescription medication), or remains refractory to appropriate medical therapy over a period of 3 months; and
Photographs with pannus lifted to document presence of intertrigo.
While Dr. Shoen's office submitted photos to Aetna, I started my documented treatment for my rash a few days after my visit with Dr. Shoen with my primary care physician. My PCP gave me a prescription for the rash and I scheduled follow ups with him for every month for 3 months so I would have the required documentation for approval via the Aetna code. I was anticipating that I would have to wait until the required 3 months of rash documentation past before I would be approved for the procedure. However, as I was approved before I even went for my one month follow up visit with my PCP.
I wanted to post about this as I didn't see anything about Aetna approving a panniculectomy in the past few years when I was doing my research and was a bit disheartened. I am still paying out of pocket for the TT and liposuction (a little over $7,000), I think that having the coverage lowers the cost enough to try for approval. Best of luck to all hoping for Aetna approval of a panniculectomy in 2017.
Also, the other surgical coordinators and surgeons told me that Aetna NEVER approves panniculectomy claims so that they would not even try to submit one on my behalf. It took a little coaxing on my part, but Dr. Shoen's office submitted my claim and I was approved by Aetna for coverage of my panniculectomy on my first submission. Dr. Shoen's office submitted pictures of my extremely loose and low hanging skin (below pubis) and subsequent rash caused by the skin fold irritation. Please note that the code for panniculectomy, 15830, asks for the following:
Panniculus hangs below level of pubis, documented by photographs; and
The medical records document that the panniculus causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs over 3 months while receiving appropriate medical therapy (e.g., oral or topical prescription medication), or remains refractory to appropriate medical therapy over a period of 3 months; and
Photographs with pannus lifted to document presence of intertrigo.
While Dr. Shoen's office submitted photos to Aetna, I started my documented treatment for my rash a few days after my visit with Dr. Shoen with my primary care physician. My PCP gave me a prescription for the rash and I scheduled follow ups with him for every month for 3 months so I would have the required documentation for approval via the Aetna code. I was anticipating that I would have to wait until the required 3 months of rash documentation past before I would be approved for the procedure. However, as I was approved before I even went for my one month follow up visit with my PCP.
I wanted to post about this as I didn't see anything about Aetna approving a panniculectomy in the past few years when I was doing my research and was a bit disheartened. I am still paying out of pocket for the TT and liposuction (a little over $7,000), I think that having the coverage lowers the cost enough to try for approval. Best of luck to all hoping for Aetna approval of a panniculectomy in 2017.
Provider Review