Seeking advice for a slightly unique situation.

Tigerlily9731
on 9/18/17 6:24 pm

Hello! Thanks in advance for any responses. My questions are about a mixture of insurance, finance, procedure and generally looking for a little light at the end of the tunnel.

I've researched my issues for months but I can't find answers that put my mind to ease due to my cir****tances.

A little bit of background information. I'm female, fairly young, I underwent my VGS about 5 months ago and am down 70 lbs, closer to 100 including the required pre surgical weight loss. I have been very overweight since early childhood and still have a ways to go even though the journey so far has been mostly worth it. Like a lot of people here my concern is loose skin. I knew it was guaranteed but I didn't expect it to be such a severe problem so soon. It already has a huge impact on my ability to exercise and I've hurt myself a number of times because of it during said exercises and basic daily activities. It's never NOT making my life difficult.

A full body lift is inevitable. I mean I can already see that it will be absolutely necessary for me to achieve some quality of life. My goal would be to begin the consultation process at the 1-1.5 year mark, though it stresses me out to think about waiting even that long because of how troublesome the extra skin is. My fibromyalgia pain has become worse since the weight loss oddly enough, and I feel like the unusual proportions might have something to do with it especially because of increased physical activity/exercise. I'm on disability and state insurance which covered the bariatric surgery, but how much help will they be from here on out?

My regular physician says that they might cover the tummy and maaaaaybe chest, but anywhere else is way harder to get approved for. There are other areas of my body that are just as problematic as those two, especially my arms. I'm assuming the worst in that 90% of my body work would be an out of pocket expense.

I'd take being in debt for the next 20 years over staying like this and however worse it gets after the next 50+ lb weight loss, but my fixed income is very low on paper and I doubt any credit companies/loaners will be interested in financing the surgeries even though I can afford many of their monthly fees... depending on the final price tag of course. I'm in MA btw.

I guess my questions are... what kind of luck have you had on getting insurance to cover procedures, especially the ones I've heard are often turned down? I know documentation is important but my doctor can't be with me every day and the complications don't always translate well in photos. I see my doctors as much as I can which is abnormally often to begin with.

Is there anyone on a low fixed income who managed to get their full body lift? How did you do it? Are you familiar with pricing in my neck of the woods? Is there any hope?

Gwen M.
on 9/19/17 7:16 am
VSG on 03/13/14

Really the only way to get these questions answered is to call your insurance company and ask them what their requirements are. Your PCP isn't going to be able to tell you this - my PCP is woefully uneducated about reconstructive surgery and was utterly shocked when I told her I had to pay for all of mine out of pocket.

Call your insurance company and ask exactly what they cover and what documentation they need. Knowing for sure is better than guessing or wondering!

VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)

Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170

TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)

Laura in Texas
on 9/19/17 8:39 am

My insurance did not cover any of my plastic/reconstructive surgeries. I lost 200 pounds and was in my 40's when I had my gastric bypass. I had a lot of excess skin.

I scrimped and saved for my plastic surgery and financed part of it. I had to do it for my mental health. I did not get all parts fixed that probably need fixing. I got the parts that bothered me most done and made peace with the rest. I love my body now, imperfections and all.

Since you said you are young, there is a lot of time to gain more income and/or cut living expenses. Community Colleges offer a lot of financial aid and there are a lot of programs to help you advance in your career or find a new career. I teach summer school, tutor, babysit, and makes things to sell to earn extra money. I also take good care of my vehicle so that I can drive it a lot longer (it's currently 11 years old). Cut out cable. Think outside the box.

Make a plan if you want it done.

Laura in Texas

53 years old; 5'7" tall; HW: 339 (BMI=53); GW: 140 CW: 170 (BMI=27)

RNY: 09-17-08 Dr. Garth Davis

brachioplasty: 12-18-09 Dr. Wainwright; lbl/bl: 06-28-11 Dr. LoMonaco

"May your choices reflect your hopes and not your fears."

Knitter215
on 9/19/17 11:38 am
VSG on 08/23/16

Go to the online portal for your insurance and search bariatric plastic surgery. See what comes up. It really depends on your policy. And while the policy you have now may not cover it, the policy you have in a year might cover it, if you make your choices wisely at open enrollment time.

I knew my carrier would cover a Panni - and I knew that I could get the girls lifted because I have a history of shoulder and neck pain from big boobs. But when I read my company's coverage memo for my policy, I found out that my carrier (Harvard Pilgrim) for the policy I have covers removal of all excess skin which interferes with activities of daily living, and some other criteria.

So, what you need to do is talk to the carrier and then find a plastic surgeon who is on your plan, who does this type of surgery and talk to him/her and their office people about all this.

I'm down 102 pounds and having my first consult to document my issues with my surgeon at the end of October. I don't plan on having anything done for another year, but I need to start the process so there is documentation.

Keep on losing!

Diana

HW 271.5 (April 2016) SW 246.9 (8/23/16) CW 158 (5/2/18)

Sharon SW-267
GW-165 CW-167 S.

on 9/23/17 11:29 am - PA
RNY on 12/22/14

I agree with the advice given about checking out your insurance.

are you wearing correct supportive/light compressive garments while you exercise? See Marena website (maybe availble for less else where)

Sharon

Tigerlily9731
on 9/23/17 12:15 pm

Thank you everyone for the responses and advice, I really appreciate it.

As difficult as this journey is, I love reading about what you've all endured to get where you are now. It's at least reassuring to hear that there are others who have been there and understand. :)

I've done some digging through my insurance policies and as I thought it does say that they only cover plastic surgery if it's considered medically necessary. It's just a matter of how hard they push back in regards to what they think is "necessary". They covered the surgery so I'm keeping my fingers crossed that they will at least remove SOME of the skin in the vital areas, though I know practically rebuilding a whole person is going to cost plenty of money regardless. Anything I can convince them to do will help.

I've made an appointment with a couple of doctors who were involved with the process so I'm hoping to get some more answers so I can be better equipped when I call the insurance directly... they've given me the run around about the simplest things so much in the past.

I do wear some compression and "shapewear" garments almost all the time but I've had a really hard time finding stuff that's the right fit, but I'm definitely going to look through that website and see if I can find any more weight loss friendly pieces. Thank you!

NYMom222
on 10/7/17 9:11 pm
RNY on 07/23/14

My insurance weirdly paid for part of some of the Hospital bill and nothing else. Every insurance is different.

Compression garments like spanx can be your friend right now. They also have lighter weight ones like flexees brand and I've bought ones in Soma I like when they are on sale. COuldn't always tolerate the heavy duty ones.

Cynthia 5'11" RNY 7/23/2014

Goal reached 17 months. 220lb Weight Loss
Plastic Surgery Dr. Joseph Michaels - LBL and Hernia Repair 2/29/16, Arm Lift, BL, 5/2/16, Leg Lift 7/25/16

#lifeisanadventure #fightthegoodfight #noregrets

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