HELPFUL HINTS FOR GETTING RECONSTRUCTIVE SURGERY APPROVED AFTER WLS

1. Takes pictures of every rash, sore, bump, mark, cut and infection you get as a post-op anywhere on your body - you never know where you might want to get skin removed, and mark the picture with the date and how many months post-op and pounds lost.
   

2. Call your PCP every time you get a rash, sore, bump, mark or infection and ask them to prescribe a cream for you - mine always prescribed medications.  Keep your receipts and labels in preparation for your letter (see #3)
   

3. Talk to your PCP NOW  so that when you approach your goal weight, you will be asking them for a letter of medical necessity for skin removal procedures. Ask your doctor to document every complaint you have about skin disorders, back pain, neck pain, shoulder pain, joint soreness and the like - it will help them write a more compelling letter a year down the road.
   

4. Take your own photos of hanging skin every 3-6 months, date them, list months out, pounds lost, and any problems the skin is causing.
   

5. When you go to your post-op visits with your WLS  surgeon, Ob-Gyn, Chiropractor or Physical Therapist tell them of your skin problems, back/neck/shoulder/joint pain, and tell them you may be asking them for a letter of medical necessity when it comes time to remove skin so they can start documenting now  in case the letter from your PCP isn't enough.
   

6. Learn the vocabulary and school the insurance person at the Plastic Surgeon's office in case they don't know - if you are not confident, ask them to let you review the request before it is submitted to insurance. Things to know: plastic surgery is never covered by insurance, reconstructive surgery often is. Elective procedures are never covered by insurance, so make sure yours is listed as medically necessary.
   

7. For you writers, when you journal, highlight the section where you talk about how your loose skin is starting to affect your quality of life, just in case you have to write an appeal letter later, you can look back on these notes to help you draft it.
   

8. Never take no for an answer. Read your insurance policy and tear it apart and get a full understanding of what they need for documentation. You should have all of your documentation to show you have the need for surgery so use it. Do not count on your surgeon to do it all. They have other patients besides you and sometimes get sidetracked. No one knows your issues better than you. Read  your insurance letter before they submit it.  Many plastic surgeons do not include necessary information as they hate dealing with insurance and they prefer you to pay cash. When they accept insurance they have to take less cash. Be your own advocate and read your letter before it is sent to be sure the things the insurance company care about are covered.
   

9. Insurance companies do not not care that you have issues fitting into clothes and have to buy larger sizes or that your appearance is disfigured. They care about rashes, infections, back, neck, and shoulder pain, body odor, medications you have used to get rashes and infections treated, and the amount of time you attempted to treat the problems. Most insurance companies require 3-6 months of documentation. Save everything.
   

10. Document everything. Send it to them yourself and keep the originals as they always have a habit of loosing pertinent information. The main thing is to never give up. Do your research and be armed. Never let your emotions get to you during a hearing or appeal. They do not care about tears. Stick with the medical information. They are money hungry and try to save every cent even if it means you suffer because of their thriftiness.

Copyright 2003 [PFAMOS]. All rights reserved