The member had had gastric bypass surgery three years previo…
The member had had gastric bypass surgery three years previously. As a result of losing over 200 pounds, loose skin hung from the member’s arms, thighs, and belly. The member, upon referral from her general surgeon, was scheduled to have a plastic surgeon remove the excess skin. The member called for prior approval as required by the plan. The clinical review resulted in a denial of the surgery as cosmetic. The member requested a peer review and submitted documentation from her physician that the excess skin was causing skin infections and exacerbating her eczema. The peer clinician denied the case. What is the member’s next step if she is determined to have the surgery?
Read DetailsYou have just placed a female who is 9-months-pregnant on a…
You have just placed a female who is 9-months-pregnant on a backboard. The patient was stable prior to this and was complaining of back pain. She is now unresponsive, is breathing rapidly, and has a weak, rapid pulse. Which of the following is your MOST immediate priority?
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