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doctor won't send my insurance. need surgery.
Mar 21, 2012

MY HIV doctor won't send my insurance (HIP Medicaid). the danger is lipodystrophy and I'm at high risk for heart disease. Most of my fat is abdominal. My plastic surgeon got me approved for a panniculectomy / abdominalplasty surgery. My whole ab needs to be reduced and re-constructed but the plastic surgeon is only going to do below the belly button. Neither doctors are acting like HIV is serious medical issue and Lipodystrophy for a women who is 168lbs. My plastic surgeon ask for me to take out a carecredit.com loan for $2800 to do the top of my abdomen. I feel like I'm being hustled. I have a GMHC cobra case manager helping me with this issue but the deadline for panniculectomy surgery is 6/24/2012. How can I get a full abdominal surgery from your point of view?

Response from Mr. Chambers

I'm afraid I'm a little confused. Is your coverage with Medicaid or COBRA continuation through GMHC? Or is a case manager from GMHC helping you with this issue?

Im also not sure what you mean by "My HIV doctor won't send my insurance." Are you on an HMO through GMHC COBRA and your primary care physician (the HIV doctor) must provide the referral for the surgery?

I guess my main question is has your insurance (Medicaid or COBRA) approved coverage for your surgery completely or just the "below the belly button " portion and denied the remainder? If they have denied the upper torso surgery, you and your case manager, along with your plastic surgeon should appeal that decision, focusing on the medical necessity for the total surgery.

If you could clarify the issue for me, I would like to try to help you more. Meanwhile, I suggest you work with your case manager and postpone getting the "carecredit" loan for now.

Let me hear back from you. Jacques



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