POSTED UNDER Panniculectomy REVIEWS
I need skin off. but insurance company playing games
ORIGINAL POST
I need skin off. but insurance company playing games
Well been working on this since Nov of 2016. But decided to wait till lost more weight. Highest was 350lbs was 276lbs, currently 260lbs had gastric sleeve in 2013. Lowest was 220lbs in may of 2014. But lower stomach is hanging, pulling, severe back pain, rashes, smells, boils, and bleeds. Going to dr Matthew endara. Started back in Jan of 2017. My health insurance is jacking me around. They started saying they never received and paperwork from the dr office 3 times. Now I received a letter saying denied because they don't have pictures. I clearly have taken pictures at dr office. A co worker of mine just had hers done was approved within a week after seeing the dr same insurance. now I have only two weeks to appeal.
ahinton's provider
Replies (9)
March 14, 2017
I'm going through the exact same thing! When I called my insurance company they said "it is not covered under your policy BUT since it is medically necessary have the doctor send in the approval". Then the doctor calls and they say "it explicitly says 'no surgery due to weight loss or excess skin is covered'". I'm just tired of carrying this extra weight around and don't have the means to take care of it.
Let me know how you handle yours so I can get some tips to fight mine. Good luck!
March 19, 2017
First who do you have for insurance? I started with my primary doctor, complaining about my skin rashes, cracking of skin, discoloration, etc. Making a history of my skin problems went once a month for 6 months. Had the doctor do my appeal and mail my pictures to there office. So they can't say they were black squares this time.
March 19, 2017
Community health. I'm trying to switch my policy to cover it. I'm going to make sure my PCP is making all of these notes for me. Just don't want to be in pain anymore. It's killing my back.
January 27, 2018
Sometimes insurance considers this cosmetic surgery. I just had skin removed and tummy tuck 2 weeks ago. I did not do the muscle repair bc mine were fine from working out. There’s certain ways to get it done. I chose to do a intrest free credit card for 18 months. Also chose to go home the same day and that saves a lot. Hospital Stays are expensive. Hopefully you get the surgery done my life has changed so much and I can’t wait to get back in the gym. I was 288 after I had my daughter and now 223! I still have goals but I feel so happy!
January 27, 2018
I have a different insurance. My friend and I have the same she got hers done. I working on that. I did a new update on my post. I don't have the extra money to pay for it myself. Just getting the apron remove will help a lot.
UPDATED FROM ahinton
New update Dr workers supposed to send in…
New update Dr workers supposed to send in the appeal in its only downstate. Today called insurance office to see if they received it. By mail and,email. They said no. Now I gave the office people the address to where to send it only takes two days by mail. Asked them how longs it takes to scan it into their system after its mailed they said 2 days. I getting jacked,around on both ends so pissed off. Now let me owe one of them some money. They'll be calling all the right people then. Sent a friend their a few weeks ago her stuff is already approved with her Healthcare paperwork sent in on time. My co worker got the same health insurance I got and was approved in a week in a half. And her surgery was done in 30 days after approval. I'm like what they got against me. I think I'm going to go to another Dr. This some straight [RS bleep]. They going to see me today in person.
Replies (2)
February 15, 2018
This is a sign heed the warning this isn’t the treatment you deserve me personally I would find a dr practice that has my best interest I would not have went back and forth . This is a very major surgery and requires a experienced ps and staff . Good luck you’ve done your part loosing weight check dr Ramenini he is caring concerned well professionally and his staff Good luck!
UPDATED FROM ahinton
New health carrier.
Well hello everybody I restarted this journey again January of 2018 with a new health care. so I get a call January 22nd from the doctor office from Laura says your insurance denied your claim they said they don't cover this type of surgery. I say that's impossible because I'm know for a fact they cover this type of surgery I recommend to people the doctor who works for the same company and have the same health care then I do and they were approved. so I calls pre claims office try to asked why was I denied. Claim office state you were not denied
we closed out your case. I said closed out, I say is still a No to me. why did you close my case? They states we didn't get the proper documentation from your doctor office. ME: well what was missing? THEM: we can't tell you that only the referral specialist can you can't speak to that office. ME: how would I know was missing? THEM; you have to talk your doctor office that handled the case call the doctor office. IM leaving messages no one answers I to the Dr office then over she comes out she with a paperwork where I really can't read it I had surgery on my eyes are still healing I did notice no pictures asking where they sent. and she tell me I don't know if they were sent. ME: WHAT do you mean you don't know do you think you go check could you check to see if they where sent. How can then see my problem without pictures.
she comes back really can't tell me she can't tell if they were sent I go back to the car call my health company this time explained whats going on. They put me on hold they call a claim office and the doctor office she comes back and stays well I think your doctor office actually dropped the ball your case is not denied it was closed. they asked for more of my documentation they have 5 days to respond back and they did not so they closed the case out. she said but you're not deny they closed it. They will resubmit the paperwork she says calls by Friday to see if his resubmit it to make sure I get them back on the ball for your case. I called the claim off its still not resubmitted. Call laura sent to vm. Called to talk to office supervisor Rodney sent to vm. Waiting for call back nothing. Guess I be making another appt with the Dr to complain about his staff. Not answering back. Beyond pissed office sending this Dr people. They get done and I can't get no f n help straight b.s. I'll be putting his office on blast in the updated. He's a good Dr his staff sucks.
we closed out your case. I said closed out, I say is still a No to me. why did you close my case? They states we didn't get the proper documentation from your doctor office. ME: well what was missing? THEM: we can't tell you that only the referral specialist can you can't speak to that office. ME: how would I know was missing? THEM; you have to talk your doctor office that handled the case call the doctor office. IM leaving messages no one answers I to the Dr office then over she comes out she with a paperwork where I really can't read it I had surgery on my eyes are still healing I did notice no pictures asking where they sent. and she tell me I don't know if they were sent. ME: WHAT do you mean you don't know do you think you go check could you check to see if they where sent. How can then see my problem without pictures.
she comes back really can't tell me she can't tell if they were sent I go back to the car call my health company this time explained whats going on. They put me on hold they call a claim office and the doctor office she comes back and stays well I think your doctor office actually dropped the ball your case is not denied it was closed. they asked for more of my documentation they have 5 days to respond back and they did not so they closed the case out. she said but you're not deny they closed it. They will resubmit the paperwork she says calls by Friday to see if his resubmit it to make sure I get them back on the ball for your case. I called the claim off its still not resubmitted. Call laura sent to vm. Called to talk to office supervisor Rodney sent to vm. Waiting for call back nothing. Guess I be making another appt with the Dr to complain about his staff. Not answering back. Beyond pissed office sending this Dr people. They get done and I can't get no f n help straight b.s. I'll be putting his office on blast in the updated. He's a good Dr his staff sucks.
Replies (4)
January 27, 2018
Sounds horribly frustrating. I applaud your steadfast efforts to get his done. clearly the run around is what your getting and they are getting what they wan, which is to keep Your money. Idiodic (sp). I scanned over your note but my 1st thought is that some ins. companies need a "dermatologist consult" in addition to "plastic surg consult" confirming. My advise is to keep hounding BUT ALSO ( if you haven't already), get copies of all records from dermatologist/plastic surg, indicating all that you are going through and give you pictures taken by Drs. Then, when the ins. says they didn't get this or that, You ask specifically what is lacking, make a list & YOU send it and get a confirmation page/ email. Another possible issue is that w/ ins. coverage change, this may have made them "close it" due to the year's end.
I hope this helps... here for your support. thanks for posting.
I hope this helps... here for your support. thanks for posting.
January 27, 2018
also, your plastic surg may need to make another plea to the insurance co. Another possibility is if the ins. co prefers one surgeon over another for easier approvals may need to switch----just a thought.
February 27, 2018
I tried everything even asking for the address to send my own file in. They will not give me the address and keep saying it has to come from the Dr office. I'm about to write a update.
How frustrating for you having to fight them like this! What is the next step? Are you needing to resubmit everything again?
I have my fingers crossed that this will all come through for you this time.