PS and insurance coverage - advice please!!

Hi everyone!!  I have not posted in sooooo long!  I am 4 1/2 years post RNY and I'm doing awesome.  I lost close to 200 pounds in the first 12 months after my surgery and I've been able to maintain :-)

I am 6'3 so my weight was very well distributed so I don't have massive hanging skin but I do have some!  I never even dreamed I would be able to "fix" myself with PS but now I'm thinking I'm going to give it a shot!!  The worse they can do is tell me NO! 

I have BC/BS Federal (anyone else???) and they covered my RNY back in 3/08.  I have called to see if they would cover PS and they just say "if it is medically necessary" but they don't give any guidelines.  SOOOO, I have an appointment for a consultation next Wednesday and I pray that between what the doctor writes, the letter I'm going to write and the awful pictures we will send in that they will cover some if not all of the surgery.  I would love to have a LBL, but a TT would be priority. 

I would love to hear your advice on what to stress to the surgeon, as well as what to write in my personal letter to the insurance company.  I don't really have any documented "problems" from the hanging skin.  I would hope that just based on the extreme amount of weight loss they would help me out!!

I'm in the Cincinnati area.

Thank you all so much!
Jen 

I have BCBS Federal (I am in Cinncinnati also!) and I was approved for a panniculectomy with no problems. I had months of documented problems with back pain and a plastic surgeon sent in pictures of my hanging skin. When I talked with BCBS Federal, they said panniculectomy and abdominoplasty were possible covered benefits, but thigh, arm, and butt lift were not.

Additionally, I had four consults and NO doctor would submit to insurance for an abdominoplasty, or any procedure other than the panniculectomy. Two doctors would not even really work with insurance at all. But I did find two surgeons who said they will be willing to take the insurance payment for a panniculectomy and do the additional work for the abdominoplasty at no extra cost. I went with one of these doctors, and I am going to pay for the rest of the lower body lift out of pocket to be done with the tummy tuck. 

Who are you going to see?

I have an appointment scheduled with Dr. Nguyen with UC plastic surgeons and also Dr. Jennifer Butterfield.  Who is your doctor?  Do you happen to go to support group at Mercy Healthplex?  I'm only asking because there is a meeting tomorrow night. 

So you mean to tell me the docs wouldn't even consider submitting to insurance???  What is that about?  I am floored by the "game" that docs and insurance companys play! 

I am scheduled for a lower body lift with Dr. Allison Lied on October 23^rd. She is the surgeon my bypass surgeon recommends and she has given several seminars at our support group meeting. Dr. Lied does not have any pics on her website, but she has a photo album in the office to view. She had a lot of photos to show of post bariatric patients, and she has an excellent bedside manner and a great reputation. If you are interested in her contact info, just let me know…

I also had a consult with Dr. Butterfield, and she was the other doctor who was willing to take insurance payment. She also had a lot of experience with post bariatric patients, and she was incredibly knowledgeable about the special needs of RNY patients and stressed added safety precautions. I highly recommend her for a consult!

Of the two doctors that did not want to work with insurance, one actually was not even a carrier on any insurance. Insurance pays $800 to the doctor for a panniculectomy, and the normal surgeon’s fee for a tummy tuck that I was quoted ranged $4000-$6500. Most insurance companies will not even cover an abdominoplasty, as it is rarely considered medically necessary. It didn’t bother me since they were up front and honest about it. I actually almost paid out of pocket to go to one of these two docs because I liked him so much. The consults were incredibly informative and well worth the time anyway! 

I don’t go to the support group meeting at Mercy, we actually just had our support group meeting at Good Samaritan tonight. You have to keep me posted on this lol! There are very few people in my support group meeting that have had plastics, so you can imagine my surprise when I saw your post tonight. I just went through your profile pictures and saw the pics of you at Niagara Falls….I am from Buffalo! What a small world!!

I sent you a PM with my cell phone number - I would love to talk to you!  Do you happen to work at the post office?  That's where my husband works - thus the federal insurance :-)

I haven't put new pictures on here for sooooo long.  My nephew got married in Buffalo (his wife is originally from there).  You are so right - such a small world!!!

Hi

Here is  a page I put together about getting insurance to help:

http://bodylifthouston.com/home/patient-resources/


Right click "open in new tab" on the link and it will open ina  new window.

If you visit, please please "like" the page on the little Facebook icon down at the bottom so I can get this info out to more people who may need it.

Best,

Dr. L.