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Insurance & Skin removal

Kimberly129
on 9/4/10 10:31 pm - Austin, TX
RNY on 12/02/10 with
I had read here a few times that there are some insurance that will pay for the skin removal, I was just wondering if anyone has actually ever had their insurance pay for skin removal and if so where did they approve skin to be removed from?
HW389 SW367 CW273 GW180 
1lb lost is 1 step closer to your g
oal !!
    
Deedles
on 9/4/10 11:11 pm - Highlands, TX
I have BCBSTX and they will pay for a pannilectomy IF it's medically necessary. That means I have to keep records, with pictures, of any/all rashes, infections, etc. and they also have to be documented by my PCP. I'll also need copies of any prescriptions filled to treat these rashes and infections.

It's funny...or sad....that we spend years doing everything we can to avoid getting these rashes and problems from folds of skin rubbing together and in order to correct the problem that's causing them, we have to intentionally allow the rashes and infections to occur just to prove we need the skin removed! There's just something wrong with that picture!!!
Dee ..... ><((((º>`·.¸¸.·´¯`·.¸¸><((((º>`·.¸¸.·´¯`·.¸¸><((((º>
My new G.O.A.L. ~~~~ Get Out And Live!


Includes 61lbs lost before surgery


Lblayze1
on 8/10/12 4:52 pm
I agree! I think it is ridiculous that it has to come to that for insurance to pay for it. I was told I had to wait for 6 months worth of skin rashes before thyey will pay for it. I had gastric bypass in April of this year and my surgeon wants to do the pannectomy he was hoping in October, but I have to wait! Its stupid!
Heather G.
on 9/4/10 11:18 pm
Like Deedles, my insurance will cover it if rashes or other documented complications occur.
HW: 299 / SW: 286 / CW: 175 / GW: 144-165 / Height: 5'9"
    
Cicerogirl, The PhD
Version

on 9/5/10 4:53 am - OH
Usually a panniculectomy is ALL insurance will pay for, if anyting, (and that includes ONLY the skin below the belly button... it does nothing for extra skin ABOVE the belly button).  Sometimes poeple are able to get a full tummy tuck covered as well, but that's usually only if there is a hernia that requires repair.

The arms, thighs, upper abdomen, etc. are almost never covered.  (Several of us with lots of extra skin in the arm pits and rash and other issues (e.g., infection after nicking during shaving) have attempted to get at least PART of the brachioplasty covered with no success.

Lora

 7 years out and maintaining 190 pounds lost!  

“You don't drown by falling in the water.  You drown by staying there.”

 

MultiMom
on 9/5/10 5:19 am - NH
My insurance (HMO Blue) paid for my panniculectomy without any rashes. I went the extra to have my belly button moved and then all the excess abdominal skin was removed (above and below the belly button). My belly button was sewn back in after the skin was pulled down so I still have it :)

Martha

      High 250/Consult Weight 245/Surgery 205/Now 125
 Height  5'4.5"  BMI 21.1  
     In maintenance since June 2009    

Meg_S
on 9/5/10 7:34 am - Natick, MA
RNY on 09/13/10 with
I have HMO Blue too so that's good to know!

Thanks.

Meg
Sara C.
on 9/5/10 3:14 pm - Granville, NY
What do you mean you went to the extra?  Was it an extra cost?  It would suck if they'd take the panni off and have the bellybutton in a weird place and they wouldn't fix it.  The way things are covered i'm a little scared I'll come out like Frankenstein's Monster
       
sonnieN
on 9/5/10 8:41 pm - grand rapids, MI
RNY on 05/14/08 with
a panni removal usually is just removing the extra apron of skin that goes from below the belly button. The "extra" is a full tummy tuck where they actually loosen up the skin above the belly botton and pull that down and reposition the belly button. They also tighten the stomach muscles at the same time.
curvaceousdiva
on 9/5/10 6:23 am - Hyattsville, MD
my CIGNA insurance covers the same... or a total body lift when the hanging skin reaches a certain number of inches that hangs
Babygirl got her surgery March 3rd...     She's from 339 to 200 as of 6/14/2012.. SOO proud of my bigbabygirl                                                                   
sonnieN
on 9/5/10 8:07 am - grand rapids, MI
RNY on 05/14/08 with
I had Empire Blue Cross and they paid for my panni removal and I didn't have any rashes. You really should contact your insurance company to find out what their qualifications are to cover that surgery. Also, they may deny you the first time you submit the clain or request. Don't just take that as the final answer but appeal it. My insurance denied me the first time and I sent in an appeal and it was then covered.

Sonya
midnight123
on 9/6/10 5:17 pm - Palm Beach Gardens, FL
did you ask for approval right after yor surgery or after you lost all of your weight???
did your insurance company pay for the gastric surgery as well?
midnight123    
sonnieN
on 9/6/10 7:03 pm - grand rapids, MI
RNY on 05/14/08 with
I was about 14 months post RNY so I had lost all my weight, had been stable for months and had a normal body fat %. According to my PS office my insurance co didn't do pre-approvals so they did the surgery and then submitted the request. However they did suggest that I contact them to find out if there was a pre-approval process. I was told no, go ahead w/ the srgery and then submit and they never said any of their requirements for covering the panni removal.

Turns out you had to be 18 months post op, documented rashes, stable weight for 6 months so since I didn't meet any of those I was denied. I wrote an appeal letter sating why it was medically necessary I was approved. I also think that having called in prior to the surgery and was not told any of their requirements helped. Just shows, don't give up or take no for an answer.

Yes, my insurance paid for my RNY, took them less than 3 days to call w/ my approval.
midnight123
on 9/7/10 8:37 am - Palm Beach Gardens, FL
dear sonnie,
thanks so much for the information. it is so helpful to know that you are not going thru this alone.
midnight123    
Eveningblossom
on 2/18/11 11:47 pm - Cuba City, WI
I am trying to have a panni removal done with a belly button hernia repair.

Medicare and Blue Cross/ Blue Shield paid for my band 4 years ago.

I have the panni hanging low enough to qualify.

They called and said I only have one note for a rash and the doc got me some creame.

It is not enough documentation. Monday I go back to my PCP to show him the rash is back and it is real bad.

When he lets them know I still have a rash, do you think that will be enough?

Thank you, Pat

bajwa@wild blue.net
Eveningblossom
Cicerogirl, The PhD
Version

on 2/19/11 4:25 am - OH
It depends on your insurance.  For my insurance you had to show 3 months (or maybe it was 6 months...? it's been a couple of years so I'm not sure) of unsuccessful attempts to eliminate the rashes with multiple treatments.  Just trying one product was not enough.

Lora

 7 years out and maintaining 190 pounds lost!  

“You don't drown by falling in the water.  You drown by staying there.”

 

GraceGirl
on 8/10/12 7:24 pm
Its sad we have to suffer with these rashes.
 
"If you're interested in achieving success, you'll do what's convenient. When you are committed to success, you'll do whatever it takes."

Eveningblossom
on 2/19/11 8:36 am - Cuba City, WI
Thank you very much.

Pat