14 yrs post op

nativeprincess35
on 2/17/14 2:24 am

So...my VBG was almost 14 yrs ago now. The highest weight I recall in my life was over 600 lbs (I say over because at the Dr. office the scale only weighed to 300 lbs and they put me on two scales next to each other and it was unable to to register a weight) That set me on a major change of how I ate...and a couple years later I was able to read a weight at 489 lbs.  After crushing the cartridge in my knee I decided I needed much more help with weight loss and saw a weight loss surgeon in the Spring of 2000.  My weight at that first visit (if I remember correctly) was 425 lbs.  Morning of surgery I was 414 lbs.  With in a year I had lost 103 lbs and seemed to plateau at that point.

Years of other medical issues has caused me to gain a bit of weight here and there, and loose it again.  My lightest weight was 300 lbs...my heaviest since the VBG has been 360.  I am currently down to 338 again.  My heaviest was last winter as I was suffering from endometrosis problems and ended up having a complete hysterectomy last November.  Since the hysterectomy I am having massive issue with my large hanging belly and have seriously started to look into having a panniculectomy performed.   

My local plastic surgeon seems to be a bit iffy because my main insurance is Medicare.  I have heard how difficult they can be and that they won't give pre-approval.  Has anybody had to deal with this?  I have in the past 6-7 months been having issues with rashes, skin tearing and one abscess that had to be lanced.  The belly itself hurts....plain and simple.  I can no longer ride my exercise bike because it hurts so bad when my legs rub or bump into the belly.  Lifting the belly hurts like it is bruised. Moving in bed at night hurts the belly, and that is when the skin tends to tear.   I am hoping for these reasons I can get it covered...so I can start exercising again and loose more weight.  My WLS said he would liked to have seen me at about 270 post op meaning after WLS and any and all contouring/skin removal surgeries.  

Any insight you might have is greatly appreciated.

QoftheU
on 2/17/14 5:32 am - Bay Area/Silicon Valley, CA
Revision on 12/18/13

Well, I haven't been through it, but my advice is to fight for it with all your might.  What have you got to lose (except your belly?!).  Yes, you'll probably have to jump through a lot of hoops. 

Have you DOCUMENTED all of this with doctor visits - multiple doctor visits and prescription lotions, creams, meds, etc?  They will want as much proof as you can supply.  If you don't have it, start making doctor appointments and go in there every two weeks when things don't improve.  (Ummm... not that this is legit, BUT, you can always go through all this and NOT use the prescriptions but SAY you did in order to force the issue... just sayin'). 

Just dig in your heels and don't quit.  It sounds like you've got a fighting spirit so use it! 

 

      

Leslie - Band Revision to RNY - best thing ever!   HW: 234   SW: 222  CW: Ticker  GW: 130

nativeprincess35
on 2/17/14 8:58 am

I have been to the doctor about the skin tearing and she had to lance an abscess I had too.  I don't recall if pictures were taken, but she documented the issues and measured the skin lesion.  I guess I am a bit afraid to go see the next plastic surgeon and have surgery and Medicare turn it down and get stuck with a $12,000 hospital bill

Michelle

QoftheU
on 2/17/14 10:42 am - Bay Area/Silicon Valley, CA
Revision on 12/18/13

That's why I suggested you keep going back to the doctor with complaints... you need to create a paper trail (trust me - I used to be a paralegal and paper trails are proof of need).  Do that for about 8 weeks - in other words, keep compiling evidence in YOUR favor.  Then you'll have something concrete and chronic to show them and plus, if you have to appeal, you improve your chance of winning with all that documentation.  YOU should be taking photos and printing them, and keeping a record of every little thing too.  Remember, you're building a CASE - so do the work and you stand a better chance of winning.

Good Luck!

 

      

Leslie - Band Revision to RNY - best thing ever!   HW: 234   SW: 222  CW: Ticker  GW: 130

MsBatt
on 2/17/14 12:51 pm

Medicare simply does NOT pre-approve anything, but an experienced plastic surgeon should be able to tell you whether Medicare will cover---and in your case, it certainly sounds like they would.

nativeprincess35
on 2/18/14 2:57 am

That is part of the reason I am going back to the  hospital where I had the original VBG done since they have experience with these issues.  The first plastic surgeon I saw locally seemed more than competent enough to do the surgery with it being a larger pannis he would be removing...but his nurse who deals with the insurance companies for pre-auths didn't seem confident enough to take on the case.   The surgeon I have an appointment with works with the surgeon that did the VBG so I am confident they will get it done properly and fight it for me.  I was just hoping there might be somebody else who has gone through this with Medicare.

 

Thanks for all your advice!  

Michelle

nativeprincess35
on 4/8/14 10:16 am

Well, I went back to the original hospital I had the WLS at and was given the specific guidelines to give to my GP Doc to track and follow what Medicare will approve.  I have since been diagnosed with a small hernia...literally got the call late this afternoon.  So I go see the general surgeon on Friday.  I have to go back into my reg doc cuz my belly button is massively infected right now!   I am sure it is from all the exams to and around the belly button in the last few weeks.   I literally had one dr pull my skin back and open pretty wide.....I have a HUGE belly button!   So I just noticed how red and inflamed the skin is in there.  One more thing for them to document for the panni!      

 

I am hoping with the small hernia I have now...that the general surgeon will coordinate with the plastic surgeon and do the hernia repair and then the panni?????!!!    We will see what happens now.

Michelle

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