Did Your Insurance Approve You???

Hello All,

Its almost that time for me to start thinking about reconstructive surgery on my stomach and breast... according to my dr.'s office, it may be easier for me to get my breast done, by asking for a reduction which is fine by me...but i was told that a tummy tuck is almost impossible to get the insurance company to approve...so my question is has anyone been able to get their tummy tuck approved or was your expenses covered out of pocket? If you did get it approved how did it happen and what insurance do you have? I currently have united healthcare ppo in the state of GA. while they didnt give me any trouble with approving my surgey, im wondering if its going to be a major battle with my reconstructive phase... thoughts or suggestions?

 From your data posted - you are just about a year out and want to loose more weight to reach goal.   The conventional thinking is that you be at or as close to goal as you're going to get - at least 18 months even then - and at a stable weight for at least six months.     I can't advise on how to handle insurance issues - as I had no rashes etc. to document - and insurance companies vary in their willingness to pay for a tummy tuck (most will pay for a panni with documentation of skin breakdown if they cover anything at all).   What I will tell you is that you are early enough out you will still likely loose more weight - and you do not want to have plastics before you finish.    Now is the time to get in really good shape - to tone and strengthen your body so that when you are ready for plastics you go into surgery as strong and fit as you can.  It makes a huge difference in outcome and recovery.   Susan

You need to start establishing medical necessity by seeing your doctor and getting all of the issues your excess skin is causing documented in your medical records.  This means do not self treat rashes and such.  Generally if insurance covers plastics at all it is going to be for something akin to persistent issues that cannot be managed by less invasive treatment.  You might also want to find a plastic surgeon that is accustomed to working with your  insurance.   He/she will be able to best advice you on this.  And much depends on your policy.  Get your policy book out and look for the sections on plastic and reconstructive surgery  -- and also look in the section where exclusions are listed.

Red

I was lucky enough for my insurance to approve both a TT and a BL. I don't even have any skin issues. But, I do have a lot of back pain and even went to physical therapy for it. With that being said I think the two main reasons that they agreed to pay was because I was almost two years out from WLS and I have lost more than 50% of my original weight. In addition I was lucky enough to find a really good surgeon who took my insurance. They did all of the submitting of paperwork and I was approved the first time!  I have Blue Care Network of Michigan.
It can't hurt to try.  

Good Luck,

joni

So wonderful for you!!!!!  That's so nice.  I have been battling it and I have lost 185 lbs and weigh 144 now and I still had to go in for chronic rashes etc.. and they are paying only for a pani, i have to out of pocket the rest for my LBL.. 11k :(

Hi Joni, would you be comfortable sharing in more detail about how you got approved for TT and BL? For instance, what medical reason did your doctor give for needing it done if there weren't any skin issues?

(I don't have skin rashes, but I do have back pain and I've been in physical therapy for over a year--so I'm hoping I might be able to use that for approval.)

HI, I THINK EVERY INSURANCE COMPANY IS DIFFIDENT I GOT APPROVAL IN 2 WEEK AND WAS HAVING MY T.T 3 WEEK AFTER SEEING THE DR. SO MINES WENT REALLY QUICK SO JUST TRY A PRAY. HOPE EVERYTHING WORK OUT FOR YOU.

ANGIE

I was APPROVED in 2 days... My doctors office called everything in on Monday... sent pictures on Tues.... Called me on Weds... Having surgery April 6, 2009... Tummy tuck and breast lift!!! I'm so excited...

I've already met my deductible so nothing out of pocket... I will be responsiable for 15% however... thats only after the insurance pays thier part... I got time to pay that!!!

I have Federal Blue Cross Enhance...

Give your insurance company a call... ASK THEM..
Bless you...

oh girl, i like your picture with the camera. that is very cute!

Hi Ms. Lady Sofie,
I am in the process of trying to get my insurance to cover an abdomenplasty... actually what i need is an extended abdomenplasty is what I have been told. The physician's office told me that a lot of times the insurance companies do cover a TT if a patient has had massive weightloss. I am hoping in my case it works. I think it all depends on what type of insurance you have and what it covers. The physcian's office told me today that's it's still pending approval and that they were told they needed some additional information. They are going to get the surgeon to actually talk to the insurance company to give them more information. HOpefully he will give them what they need and go from there. I think in my case it helps that I work at a hospital and my surgeon is willing to fight for me.