tonya66

Another important thing is to be diligent. Insurance companies often have tactics to discourage you from seeking approval for procedures. Usually, the insurance company would prefer that you pay for reconstructive procedures yourself. So if you are initially denied: appeal, appeal, appeal. By law, the steps detailing how to appeal are listed on any letter that informs you of a denial. Take advantage of the information, and be prepared to submit an appeal in writing as necessary. Although with insurance companies, written documentation is king. But don’t be afraid to also call the insurance company to try to find out what factors led to their decision. (That’s what I did after I was initially denied, once I found out who made the decision, I called more than once and asked if my entire file was sent. After some research, I had the file sent again to the doctor who acted as the clinical director and I was later approved. ) Once documentation is received by the insurance company you'd be surprised how often file documents are separated, lost or mislaid. So if the insurance company or a specific department of the company (like the Pre-Determination department, which often makes the decision for reconstructive surgeries) says they didn’t receive the photos along with your file - then ask your surgeon’s office send them again. If they don’t have copies of letters from your other doctors, be prepared to send those again as well. Make sure you are fully prepared with any documentation they would need to make their decision, and you are better assured of approval. NOTES - I don't really know who to give credit for, but I found it while googling on someones blog, I couldn't find a name. But It is not mine - although this person was very informative and I appreciate her cander.

I found this while searching on the net, so I wanted to save it for future reference. I'm down around 70 to 80 lbs and so far the only thing I'm experiencing is lower back pain. I still have more weight to lose, but so far everyone tells me no need for tummy tuck. But you never know, I want to have all the info I can in case I do require one. GET INSURANCE APPROVAL FOR COSMETIC SURGERY Since I previously worked at an insurance company and have discussed what I’ve learned there, I often get inquiries about how to get insurance approval for cosmetic surgery after weight loss. It is possible to have the insurance company approve payment for your reconstructive surgery. The most common type of surgery requested after weight loss is an abdominoplasty.This single surgery can make one of the biggest differences in the body – it removes excess skin and tissue of the abdomen area. This procedure is also often called a “Tummy Tuck.” Do not EVER use the term Tummy Tuck when communicating with your insurance company – they consider this strictly a cosmetic surgery term and they do not like it. Once thing I’ve learned with having worked at an insurance company is that how you communicate with them is as important as what you say. The abdominoplasty is a term used to cover a few different procedures. Two of the terms, panniculectomy and abdominoplasty are often used interchangeably, but the terms actually have some subtle differences. In a panniculectomy, the hanging or excess skin of the pannus (the lower part of your abdomen) is removed surgically.In this procedure, muscle repair may not be done – in most adults who have had weight changes or pregnancy there is often some separation of the abdominal muscles. In an abdominoplasty, this excess skin is removed and often there is a repair of the abdominal muscles if there is separation or loosening of the muscles in this area. Hernias in this area are usually covered by insurance, and the repair of these hernias is often done simultaneously with an abdominoplasty. I think the keys to insurance approval are very simple. It's difficult for one doctor to completely ignore another - so I always try to have my insurance approvals passed on to the clinical doctor in whatever group is in charge of making the decision. To make sure this happens, I include a lot of doctors' letters in any file that is going to be sent to an insurance company. By this I mean letters from your PCP or General Practitioner, letters from your OB/Gyn, your dermatologist - any doctors you have.Add these letters along with the file and photos that your Plastic Surgeon will send to the insurance company. Now after a massive weight loss, it is inevitable you'll have lots of excess skin. For that reason, I suggest you make sure that the insurance company understands that it's not cosmetic reasons that you want this skin removed - but for medical reasons. In other words, you want to make sure that they understand that this excess skin (and excess tissue, especially in the areas of your abdomen, thighs, hips etc - and perhaps even your bust) is interfering with your daily function and life. The things I would stress would be the issues that occur with excess skin. These may seem gross but they are actual medicalresults of excess or hanging skin. If your hanging abdominal skin is forming an apron of skin that hangs toward your pelvic area, then this may cause complications that can be used as justification for approving your abdominoplasty surgery. The idea is if you have any of these conditions to make sure that your doctor notes you've been diagnosed or treated with it. Or if you haven't been diagnosed but the doctor knows you are PRONE to this conditions this can be used as justification for getting your surgery before you suffer from these conditions. For example, if a female has been treated for yeast infections from her OB/Gyn, then it is perfectly acceptable for that doctor to note that the hanging skin might make you prone to that condition (even if it has not yet surfaced.) Letters from your dermatologist noting skin irritations, rashes, infections from your hanging skin or having been treated with medication for these conditions is also a very strong factor in getting approval. A letter from your urologist might mention if you've been diagnosed as having excess abdominal skin that is pressing or your bladder or urethra. This pressure can cause various urological conditions and disorders. If you’ve been treated by a chiropractor for any lower back pain, any type of alignment difficulties or other conditions that might be affected by hanging or excess skin, get a letter documenting that. It has been studied that every one pound of abdominal tissue add 10 pounds of strain on the disks of the spine and lower back. The extra weight affects the normal curve of the spine and contributes to lower back pain. In other words, an extra five pounds can add 50 lbs of strain to the lower back. And extra ten pounds of abdominal tissue can add 100 lbs of strain to the disks of the lower back and this is another reason this area common suffers abdominal hernias (this is especially true after changes in weight, pregnancy, and abdominal surgeries). Your PCP or Family doctor can also be of great help in helping the insurance company to realize that getting an abdominoplasty is reconstructive and not cosmetic. Having this doctor detail the conditions you’ve experienced is essential to getting approval for this procedure. Insurance companies are often in the business of not approving procedures that they even suspect are not medically necessary but cosmetic. Make sure that your documentation reflects common medical industry terminology (writing panniculectomy or abdominoplasty instead of Tummy Tuck, as discussed earlier) and utilizing the correct codes to document the conditions that you may suffer from. If you have even more significant excess skin that extends throughout your lower body area, then the more severe Belt Lipectomy or even a Lower Body Lift may be needed. This procedure involves a full around-the-world incision that spans your entire body. The surgical and recovery times are also more lengthy in this much more costly procedure and often insurance companies are hesitant to approve a Belt Lipectomy or Lower Body Lift without some significant documentation to show that it is needed. The CPT code for the abdominoplasty procedure is generally CPT 15831 – The excision of excessive skin and subcutaneous tissue. (This is the code that is on my insurance approval letter for my abdominoplasty.) The code for removal of excess hip area tissue is CPT 15834. With other areas included (flanks, back) it is CPT 15839. If this process includes suction-assisted lipectomy (like liposuction) then it can be CPT 15877. (Note: Insurance companies are notoriously loathe to approve CPT 15877 as they consider it cosmetic.) It is important to document that the excess skin is not a cosmetic issue but is “interfering with exercise, hygiene and health” and that it is not cosmetic. The following is a list of common industry ICD-9 codes are descriptive diagnostic codes that used to describe symptoms, in this case relating to excess skin. These can be used in the letters that describe the various conditions and symptoms that are prompting you to seek the surgery. Panniculitis 729.39 - Skin irritation underneath pannus area Large pannus 701.9 - Redundant skin, lower abdominal area Intertrigo 695.89 - Rashes & Irritation of skin in pannus area Back pain 724.1 - Back pain from diminished abdominal muscle Skin Abcess 682.2 - Can result from excess or hanging skin This is just some of the information that can be included in the documentation provided to the insurance company. I know I did not want to wait until my excess skin became a full hanging apron, so I knew I had to be persistent and diligent in seeking insurance approval.

I found this while searching on the net, so I wanted to save it for future reference. I'm down around 70 to 80 lbs and so far the only thing I'm experiencing is lower back pain. I still have more weight to lose, but so far everyone tells me no need for tummy tuck. But you never know, I want to have all the info I can in case I do require one. GET INSURANCE APPROVAL FOR COSMETIC SURGERY Since I previously worked at an insurance company and have discussed what I’ve learned there, I often get inquiries about how to get insurance approval for cosmetic surgery after weight loss. It is possible to have the insurance company approve payment for your reconstructive surgery. The most common type of surgery requested after weight loss is an abdominoplasty.This single surgery can make one of the biggest differences in the body – it removes excess skin and tissue of the abdomen area. This procedure is also often called a “Tummy Tuck.” Do not EVER use the term Tummy Tuck when communicating with your insurance company – they consider this strictly a cosmetic surgery term and they do not like it. Once thing I’ve learned with having worked at an insurance company is that how you communicate with them is as important as what you say. The abdominoplasty is a term used to cover a few different procedures. Two of the terms, panniculectomy and abdominoplasty are often used interchangeably, but the terms actually have some subtle differences. In a panniculectomy, the hanging or excess skin of the pannus (the lower part of your abdomen) is removed surgically.In this procedure, muscle repair may not be done – in most adults who have had weight changes or pregnancy there is often some separation of the abdominal muscles. In an abdominoplasty, this excess skin is removed and often there is a repair of the abdominal muscles if there is separation or loosening of the muscles in this area. Hernias in this area are usually covered by insurance, and the repair of these hernias is often done simultaneously with an abdominoplasty. I think the keys to insurance approval are very simple. It's difficult for one doctor to completely ignore another - so I always try to have my insurance approvals passed on to the clinical doctor in whatever group is in charge of making the decision. To make sure this happens, I include a lot of doctors' letters in any file that is going to be sent to an insurance company. By this I mean letters from your PCP or General Practitioner, letters from your OB/Gyn, your dermatologist - any doctors you have.Add these letters along with the file and photos that your Plastic Surgeon will send to the insurance company. Now after a massive weight loss, it is inevitable you'll have lots of excess skin. For that reason, I suggest you make sure that the insurance company understands that it's not cosmetic reasons that you want this skin removed - but for medical reasons. In other words, you want to make sure that they understand that this excess skin (and excess tissue, especially in the areas of your abdomen, thighs, hips etc - and perhaps even your bust) is interfering with your daily function and life. The things I would stress would be the issues that occur with excess skin. These may seem gross but they are actual medicalresults of excess or hanging skin. If your hanging abdominal skin is forming an apron of skin that hangs toward your pelvic area, then this may cause complications that can be used as justification for approving your abdominoplasty surgery. The idea is if you have any of these conditions to make sure that your doctor notes you've been diagnosed or treated with it. Or if you haven't been diagnosed but the doctor knows you are PRONE to this conditions this can be used as justification for getting your surgery before you suffer from these conditions. For example, if a female has been treated for yeast infections from her OB/Gyn, then it is perfectly acceptable for that doctor to note that the hanging skin might make you prone to that condition (even if it has not yet surfaced.) Letters from your dermatologist noting skin irritations, rashes, infections from your hanging skin or having been treated with medication for these conditions is also a very strong factor in getting approval. A letter from your urologist might mention if you've been diagnosed as having excess abdominal skin that is pressing or your bladder or urethra. This pressure can cause various urological conditions and disorders. If you’ve been treated by a chiropractor for any lower back pain, any type of alignment difficulties or other conditions that might be affected by hanging or excess skin, get a letter documenting that. It has been studied that every one pound of abdominal tissue add 10 pounds of strain on the disks of the spine and lower back. The extra weight affects the normal curve of the spine and contributes to lower back pain. In other words, an extra five pounds can add 50 lbs of strain to the lower back. And extra ten pounds of abdominal tissue can add 100 lbs of strain to the disks of the lower back and this is another reason this area common suffers abdominal hernias (this is especially true after changes in weight, pregnancy, and abdominal surgeries). Your PCP or Family doctor can also be of great help in helping the insurance company to realize that getting an abdominoplasty is reconstructive and not cosmetic. Having this doctor detail the conditions you’ve experienced is essential to getting approval for this procedure. Insurance companies are often in the business of not approving procedures that they even suspect are not medically necessary but cosmetic. Make sure that your documentation reflects common medical industry terminology (writing panniculectomy or abdominoplasty instead of Tummy Tuck, as discussed earlier) and utilizing the correct codes to document the conditions that you may suffer from. If you have even more significant excess skin that extends throughout your lower body area, then the more severe Belt Lipectomy or even a Lower Body Lift may be needed. This procedure involves a full around-the-world incision that spans your entire body. The surgical and recovery times are also more lengthy in this much more costly procedure and often insurance companies are hesitant to approve a Belt Lipectomy or Lower Body Lift without some significant documentation to show that it is needed. The CPT code for the abdominoplasty procedure is generally CPT 15831 – The excision of excessive skin and subcutaneous tissue. (This is the code that is on my insurance approval letter for my abdominoplasty.) The code for removal of excess hip area tissue is CPT 15834. With other areas included (flanks, back) it is CPT 15839. If this process includes suction-assisted lipectomy (like liposuction) then it can be CPT 15877. (Note: Insurance companies are notoriously loathe to approve CPT 15877 as they consider it cosmetic.) It is important to document that the excess skin is not a cosmetic issue but is “interfering with exercise, hygiene and health” and that it is not cosmetic. The following is a list of common industry ICD-9 codes are descriptive diagnostic codes that used to describe symptoms, in this case relating to excess skin. These can be used in the letters that describe the various conditions and symptoms that are prompting you to seek the surgery. Panniculitis 729.39 - Skin irritation underneath pannus area Large pannus 701.9 - Redundant skin, lower abdominal area Intertrigo 695.89 - Rashes & Irritation of skin in pannus area Back pain 724.1 - Back pain from diminished abdominal muscle Skin Abcess 682.2 - Can result from excess or hanging skin This is just some of the information that can be included in the documentation provided to the insurance company. I know I did not want to wait until my excess skin became a full hanging apron, so I knew I had to be persistent and diligent in seeking insurance approval.

Great post - I needed that :biggrin:

April 1st, a new month, and new challenges and new goals! This month I really want to focus on my exercise. I'm making baby changes and it is starting to work. Menu today bfast - well, bad, bad bad - Java chiller from sonic - liquid calories. Lunch - 2 grilled chicken tenders (came with 4, but only ate 2), green beans & turnip greens - I only ate 1/2 of each of them (We ate at Cracker Barrel) Dinner - chicken breast and multi-grain tortilla Snack String cheese Exercise - 10:00 am - 15 min on elliptical - burned 137 calories, 1.22 miles 3:00 pm - 15 min on elliptical - 138 calories, 1.23 miles 9:00 - 20 min HIIT Wt - another day I didn't weigh - yay!

April 1st, a new month, and new challenges and new goals! This month I really want to focus on my exercise. I'm making baby changes and it is starting to work. Menu today bfast - well, bad, bad bad - Java chiller from sonic - liquid calories. Lunch - 2 grilled chicken tenders (came with 4, but only ate 2), green beans & turnip greens - I only ate 1/2 of each of them (We ate at Cracker Barrel) Dinner - chicken breast and multi-grain tortilla Snack String cheese Exercise - 10:00 am - 15 min on elliptical - burned 137 calories, 1.22 miles 3:00 pm - 15 min on elliptical - 138 calories, 1.23 miles 9:00 - 20 min HIIT Wt - another day I didn't weigh - yay!

My doc said that some of the fill is always left in the tubing when he takes mine out, so he never gets exactly what he put in out, usually its a .5 cc difference. Do you feel less restriction? Or about the same? Also, sometimes the fill really doesn't kick in until about 2 weeks, don't ask me why, but it has happened to me several times. I am going for my 10th fill next Monday. I'm getting close to my sweet spot, but not quite there.

maria - so glad your pregos is going great! Sorry about the back pain, I don't recall having back pain, but it was 16 years ago, so I've slept since then. lol Weekends go by too darn fast - I felt like I didn't even have a weekend. I'm ready to take another vacation day from work and just play...... I am not a Monday's person! I hate Mondays! lol. Well, I'm headed down to our gym to do a quick 15 min on the elliptical....

Yes, I want it now! Its so weird, some days I have good restriction, other days or weeks - I feel like I can eat an entire cow. Friday night we go out to dinner, I did pretty good, I had humus, and steak and a little cabbage. The steak I could only eat about 2 oz , it was really good, but I got full. Saturday - did pretty good - no exercise, but besides that, did okay Sunday - blew it big time - ate and ate and ate, it seemed I couldn't get enougth food. grrrrrr. One week from today is my fill appointment. I'm really tired of fills, this will be my 10TH! I'm sick of them, I'm ready to hit the sweet spot and lose this freaken weight. I'm tired of yo-yoing - I've yo-yod all my life, I'm ready to be at goal! Today my menu: Bfast yogurt, granola, coffee w/cream snack string cheese lunch string cheese, shaved turkey dinner salad chicken with multi-grain wrap Exercise today: 10:00 am - 15 min elliptical 3:00 pm - 15 min elliptical 8:30 - upper body workout after workout - 4 oz protein shake wt - didn't weigh today -

Yes, I want it now! Its so weird, some days I have good restriction, other days or weeks - I feel like I can eat an entire cow. Friday night we go out to dinner, I did pretty good, I had humus, and steak and a little cabbage. The steak I could only eat about 2 oz , it was really good, but I got full. Saturday - did pretty good - no exercise, but besides that, did okay Sunday - blew it big time - ate and ate and ate, it seemed I couldn't get enougth food. grrrrrr. One week from today is my fill appointment. I'm really tired of fills, this will be my 10TH! I'm sick of them, I'm ready to hit the sweet spot and lose this freaken weight. I'm tired of yo-yoing - I've yo-yod all my life, I'm ready to be at goal! Today my menu: Bfast yogurt, granola, coffee w/cream snack string cheese lunch string cheese, shaved turkey dinner salad chicken with multi-grain wrap Exercise today: 10:00 am - 15 min elliptical 3:00 pm - 15 min elliptical 8:30 - upper body workout after workout - 4 oz protein shake wt - didn't weigh today -

Someone shared this link before, but it I think it really gives good advice on a "good fill". I'm going to try it before my next fill, my next fill will make fill #10 for me, so I'm hoping to get to that sweet spot, I'm really close! Lap-band adjustment - Laparoscopic Band adjustment in Phoenix Arizona (AZ)

I'm a major scrapbooker. Love it, totally addicted to it. Just had my corner nook in my room turned into a scrapbook section with cabinets, desk and all the goodies. Now I'm trying to get it organized so I can scrapbook. I haven't scrapbooked my journey, but I've been blogging it. I have taken lots of pictures so I'm hoping to some day maybe scrapbook it. The problem is, I haven't shared my story with too many people. My kids don't even know I have the band, only my DH and my mom. My in-laws don't know, so it kinda prevents me from scrapbooking it I guess. Unless I do it just for myself,which I might. I think its a neat thing to look back on where you began and how far you've come.

I like Designer's whey Protein shakes, my favorite. I have to mix them myself, but they are so much better than the pre-mix. If I have to do Pre-mix, I like the EAS ones, I used to love the SlimFast carb control ones, or the Atkins ones, but every since banding, my taste has changed and I hate them now. weird.

I have never smoked, not even a puff in my life. However, when I went to get the band, my doc said he would not band anyone that smokes. I know when I read some information on the band, all the sites stated smokers should quit before being banded. But I don't recall why? I know its not good for you, but not sure if it causes specific damages to the band? Lovekatz - congrats on overcoming the smoking addiction, I know many of my friends who battled it for years and trying to quit they say was the hardest thing they ever did.

So sorry for your troubles. I actually had my gallbladder removed before I had the band, I had over 50 stones they said. The pancreatitus is very dangerous, I'm sure you know that. I'm glad its healed up. I'm not sure why your having back pain, I've heard of others who experience this, I seem to have shoulder pain if I overeat, but no pain in my back. Hopefully someone will see your post and offer some better advice.

Hang in there and keep doing it. I lost weight very quickly the first 6 mos, I thought "this is going to be a breeze", well, I haven't lost 1 single pound since then. Or I lose the same 5 or 10 pounds and regain them. So losing slowly is not bad, slow & steady will win the race, trust me on this one! Making the right food choices I sooned learned and exercise is the key to success with the band. Best wishes on your journey.

Sheila, you look stunning! I'll be going for my 10th fill - yes 10TH April 7th, still searching for that sweet spot.

Jen - so glad you are feeling on top of the world, you should be, you look great too! Well, I'm happy to say I feel like I am back in the groove again. I really really do! Eating has been good, I've made it to the gym this week, and can't wait to go back! I am just feeling so much better and I finally think my 6 month slump is coming to an end. I am just a little disappointed in myself that I was in a "I don't care" mode for so long. I really do care! I hope all has a wonderful weekend. I'm hoping by Monday the scale will finally give it up and start on the downhill spiral fast!

I'm proud to say, I've been at the gym everyday this week! Each day I go, my workouts gets more intense. I'm sitting her at work this morning and counting down the hours so I can head to the gym. I feel like I really am going to conquer it this time. I want the old gym lover back. I used to be so addicted to it, then my accident happened and I'm trying to get that feeling back. I think its coming, I really do!

Oh I know how you feel. Everytime someone tells me how great I look, I have to tell them all the reasons why I don't look good. My DH pointed it out to me, i'm trying to work on that. Body image is a hard thing to change. I know you hear it all the time, but you really do look good! Your one of my inspirations! I am back at the gym again and hoping to get to my goal by this summer!

You just have to hit the ignor button to people like this. You were and still are beautiful. Don't let ANYONE tell you different!

Menu: Bfast 4 strawberries, 4 mini chicken pieces Lunch Multi Grain Tortilla filled with southwestern spicey mustard, grilled chicken and spincach leaves Snack - string cheese, shaved turkey breast Dinner - not sure, but I promise it will be healthy - DH & I have a date nite tonight :crying: Exercise - 10:00 am - 15 min on Elliptical 3:00 pm - 15 min on Elliptical planning on 9:00 pm - 20 min HIIT WT - 181 (a little shocked that it didn't go down more - but hey, I'll take it and I'm just focussing on eating right and making exercise a part of my new life again, I'm sure the scales will continue to move down!) Notes - I was so tired last night, almost blew off going to the gym, but I will not let myself down again. So, I got my tired butt off the couch, and DH even went with me. I decided to do some circuit training to burn as much calories and build a little muscle as well. I actually had a good time at the gym, yes, I really did. I cant wait to go again tonight. :biggrin:

Menu: Bfast 4 strawberries, 4 mini chicken pieces Lunch Multi Grain Tortilla filled with southwestern spicey mustard, grilled chicken and spincach leaves Snack - string cheese, shaved turkey breast Dinner - not sure, but I promise it will be healthy - DH & I have a date nite tonight :sleep: Exercise - 10:00 am - 15 min on Elliptical 3:00 pm - 15 min on Elliptical planning on 9:00 pm - 20 min HIIT WT - 181 (a little shocked that it didn't go down more - but hey, I'll take it and I'm just focussing on eating right and making exercise a part of my new life again, I'm sure the scales will continue to move down!) Notes - I was so tired last night, almost blew off going to the gym, but I will not let myself down again. So, I got my tired butt off the couch, and DH even went with me. I decided to do some circuit training to burn as much calories and build a little muscle as well. I actually had a good time at the gym, yes, I really did. I cant wait to go again tonight. :biggrin:

Congratulations. I would like to give you advice, the lap band is not easy, its a tool - i'm sure you've heard that before. So, try and start exercising - walking 10 min a day 3x a day would be a great start. Try and add exercise to your life, and you will be amazed the progress you will make. I did great my first 6 months, then had an accident and was on crutches/wheel chair for awhile, I have lost anything in the 2nd 6 mos of my post op - gain then lose the same darn weight. I've just now started getting serious about my exercise again. I know that is the key.

Susie, congratulations! Thats great about the weightloss. I get my next fill April 7th, and I cannot wait! I've started planning my meals out this week, weighing and measuring my food. Seems to be working for me, I'm not even that hungry now. I think I still need just a slight fill, not much, just about .1 or .2 cc's. I am going to ask the doc to just add some in - he always takes all my fill out and then goes from there. I think he should just add a little and be done with it, but he always wants to take everything out, really bugs me.