Lipoatrophy Reconstruction Reimbursement- Frustrations and Tribulations

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This is an email from a patient who just does not know what else to do about getting reimbursement for lipoatrophy reconstruction. I wish we could help him somehow, but to be honest I really do not know what to do. Does anyone?

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hello nelson,

I hope all is well with you. Its been a while since I last emailed you. I have been working myself into a frenzy trying to find a solution to my problem. The first thing I did was email GMHC but that was about 2 weeks ago and they have not responded. The next time I have a doctors appointment, I am going to have to drop in on them and see if the can be of any help (my doctors office/clinic is in the same building as GMHC).

The other thing I did was I emailed a doctor that was recommended by a friend and basically asked if he could do the work pro bono being that I can get the sculptra for free, he did respond but told me that he is not experienced in working with sculptra or hiv positive patients.

Then I called up the office of doctor Minas Constantinides ( I got his name from thebody.com ) and asked them what it is that I need to get this procedure covered by my insurance (as you know I have medicaid and medicare and ssi) The secretary there was very nice but she told me the really dont work with any type of insurance company. She suggested I apply for " care credit" which is a credit card that plastic surgeons work with to cover "cosmetic procedures". She told me almost anyone can get this card, I applied and it 0% interest if you pay it off in the first 3 months and if not its 17%!!!! There is no way I can afford that on my income which is provided to me by SSI. She did however advice me not to try to get medicare to cover it because the way they work it is I have to pay out of pockett for the procedure myself, then IF I can prove medical necessity by a doctor and such, they will then decide IF they will reimburse me for the cost, she told me that once they find out that I paid for the procedure, they will NOT pay for anything, no matter what, this has been here expreince.

I then called medicare myself and they told me the same thing, if I can prove medical necessity, they will pay for it AFTER I pay out of pockett. Everyone I talk to advices me strongly not to do this.

So you see I dont really know where to turn, my social worker says GMHC wont really be able to help with this, they are more advocates for people that are having some sort of legal problems but Im gong to try anyway. I should also mention that on thebody.com I did find someone with basically my same problem but it wasn't clear if he got medicare to pay for the procedure or not, I will copy and paste that letter here.

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How do I get my insurance to pay for my facial wasting treatment?Jun 28, 2008

Hello -

I hope this finds you well. I wanted to check in with you to see if you were aware if there is any insurance coverage for silicone treatments for facial wasting. I have had several sessions, and it works great. It is not cheap, of course. I am in need of a refresher treatment. I should mention that my insurance is Medicare A,B and D. I receive my meds through a Blue Cross-Part D plan, backed up by ADAP.

Neal

Response from Mr. Vergel Neal,

It is difficult to get reimbursement for Silikon 1000 since it is an off-label use for facial wasting, but you have nothing to lose and a lot to gain if you have your doctor write a medical necessity letter to send to your insurance company.

Here is a letter that Dr. Doug Mest wrote for my web site facialwasting.org for Sculptra. You can have your doctor use this letter as a template and also to use these scientific references. You can also visit the wonderful resource guide that TheBody.com has created for trying to get coverage for facial lipoatrophy reconstruction options from your insurance:

http://www.thebody.com/lipo/insurance.html

References for silicone and facial lipoatrophy:

http://findarticles.com/p/articles/mi_m0PDG/is_2_4/ai_n13559216

this situation has me very depressed and as a result, Im becoming even more introverted. Any information and help you can provide would be greatly appreciated. Thank you so much for your help.

Regards, VergelDirectorProgram for Wellness Restorationpowerusa dot orgGet fantasy football with free live scoring. Sign up for FanHouse Fantasy Football today.