After the weight loss insurance will pay for excess skin removal??

(deactivated member)
on 12/12/11 11:10 pm, edited 12/12/11 11:11 pm - IL
 I know I am a newbie but is it true that insurance may pay for lifts or removal of excess skin after bypass? Does the surgeon automatically suggest this? Will the surgeon help get you approved for the plastic surgery? What are the requirements?How long after you reach maintenance weight or size can you put in for this surgery? How long does the process take and what is the procedure? Thank you in advance you all have been so helpful
sjweiser
on 12/13/11 12:37 am
RNY on 02/25/11 with
 Hi, if you excersize you may not need that kind of surgery. I lost all my weight and I do not need
that type of surgery because of excersizing.

labellavita1982
on 12/13/11 6:38 am - Neenah, WI
On December 13, 2011 at 12:37 AM Pacific Time, sjweiser wrote:
 Hi, if you excersize you may not need that kind of surgery. I lost all my weight and I do not need
that type of surgery because of excersizing.

I disagree with this. I exersice every day and lift weights and I still have a ton of excess skin.

        
HW-500lbs SW-381 CW-235 GW-185
Steph
LOSE150
on 4/22/14 6:22 pm

How old are you and what type of eexercise plan did you do after the GBP?

goldamyfish
on 10/3/14 10:36 am

Exercise does not get rid of excess skin, just fat. Fat must be cut away. It tightens a little in time, but hardly.

poet_kelly
on 12/13/11 4:17 am - OH
Insurance will usually pay for skin removal IF the excess skin is causing a medical problem, like a rash or infection, that makes it medically necessary.  They will not pay just because it looks bad.  It's usually recommended that you wait until you've maintained your weight for at least six months.  In order to get insurance to pay for it, you'll need documentation from your doc (surgeon, PCP, both, doesn't matter) that the excess skin is causing a problem AND that you tried medication for the rash/infection but that didn't clear it up.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

Laura in Texas
on 12/13/11 5:33 am, edited 12/13/11 5:35 am - Cypress, TX
The overwhelming majority of us will have excess skin after RNY no matter how much exercise we do. Many insurance companies will not pay for reconstructive surgery. Check with your insurance company to see if it is a possibility and what their requirements are. If your insurance company will not cover it, start saving now or make sure your credit is in good shape so you can get a loan when the time comes.

Laura

wendydettmer
on 12/13/11 5:41 am - Rochester, NY
When my approval letter came in the mail, it clearly stated that excess skin is a known side effect of the surgery and is not covered. I'm sure they would if medically necessary, but they will probably make it hard lol.

Follow my vegan transition at www.bariatricvegan.com
HW:288    CW:146.4   GW: 140    RNY: 12/22/11  

      

macortiz
on 12/13/11 6:48 am - Royal Oak, MI
My insurance won't cover anything except a tummy tuck, and I thin that may be changing with the new contract when our insurance renews. Anything else is considered cosmetic.

I too excercise and I have extra skin. My problem areas seem to be my thighs and my arms, though. 

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paranoidmother21
on 12/13/11 7:26 am - Lake Zurich, IL
RNY on 12/16/09 with
It's totally variable depending on what your insurance covers - and that, in turn, is dependent on what your provider (whoever contracted for the policy, probably your employer) told them to cover.

Mine covered all the excess skin removal, but I had documented medical issues from it beyond the typical rashes that I had support from my PCP, gyny, a breast specialist, an orthopedic surgeon, and a PT. I'm still surprised they covered it all.

Your WLS surgeon would probably only be involved to the extent of telling the insurance company that you're done losing and successfully in maintenance - the rest comes from other specialists.
Rebecca
Circumferential LBL, anchor TT, BL/BR, brachioplasty 12-16-10 Drs. Howard and Gutowski

Thigh lift 3-24-11, Drs. Howard and Gutowski again!
Height 5' 5".  Start point 254.  DH's goal: 154.  My guess: 144.  Insurance goal: 134.  Currently bouncing around 130-135.
      
(deactivated member)
on 12/13/11 11:05 am
RNY on 08/29/11 with
 Hi, I my plan is very generous and provides for plastic surgery after WLS as well. But, I am curious... did your plan pay for a breast lift (etc.) as well? My plan reads, 'It is is Company XYZ intention to restore the body after WLS through plastic surgery." I just am not sure what that means, exactly.
paranoidmother21
on 12/13/11 11:28 am - Lake Zurich, IL
RNY on 12/16/09 with
Yes, mine covered everything in my siggy line.  They would not have covered implants, although if I'd opted for them I would have had them included at the time of my thighs/legs, and would only have had about $6000 in costs for additional time and materials, rather than the over $9000 to have them done separately.

Pretty much insurance seems to mean what it means on whatever date you ask... and it may not mean the same thing on another day.  Kind of like dealing with the Red Queen from Wonderland, but if you get your ducks in a row, it sounds like you've got a good chance of getting reconstruction.  A tip from my surgeons is to NEVER mention plastic surgery - always refer to it as reconstruction, as that implies medical necessity while plastics implies vanity.
Rebecca
Circumferential LBL, anchor TT, BL/BR, brachioplasty 12-16-10 Drs. Howard and Gutowski

Thigh lift 3-24-11, Drs. Howard and Gutowski again!
Height 5' 5".  Start point 254.  DH's goal: 154.  My guess: 144.  Insurance goal: 134.  Currently bouncing around 130-135.
      
(deactivated member)
on 12/13/11 11:30 am
RNY on 08/29/11 with
 Many thanks!!
sweetnsoon2bpetite
on 3/6/13 3:42 am - Seattle, WA

Thank you for sharing your wonderful success story! You are an inspiration to me.

I have gone from 427 lbs. to 270 lbs and my goal is 190 lbs. I have an enormous amount of excess skin on my back, stomach, thighs and arms. I have been exercising steadily and I am losing more weight yet not tightening any skin. I need to wear a girdle that covers me from chest to knees or my skin and my back get more painful.

I have lost count how many different skin medications I have used to clear up infections, bumps and rashes. They seem pointless because the skin problems come back within a few days of stopping the medication. My motivation is the fact that I was once unable to see my toes or walk up a flight of stairs. Now I will keep to my diet and continue exercising so that I will reach my goal weight by the end of this year. 

Which insurance plans would you recommend?  I have no problem switching health insurance plans. 

paranoidmother21
on 3/6/13 9:30 am - Lake Zurich, IL
RNY on 12/16/09 with
As I noted in my (long ago) first response, it's really not at all a matter of which insurance company. Every single insurance company will cover whatever the primary purchaser tells them to cover. It's a balancing act of how much that primary purchaser is willing to pay.

Call your insurance company and ask for specifics on what they will cover and under what conditions.

I have a friend who works in a similar job to me and has what is, on paper, the same plan. But because her employer excluded reconstruction other than following major accidents, burns, or cancer, none of hers was covered even though all of mine was. The insurance company just wrote and covered what tje employer was willing to fund.
Rebecca
Circumferential LBL, anchor TT, BL/BR, brachioplasty 12-16-10 Drs. Howard and Gutowski

Thigh lift 3-24-11, Drs. Howard and Gutowski again!
Height 5' 5".  Start point 254.  DH's goal: 154.  My guess: 144.  Insurance goal: 134.  Currently bouncing around 130-135.
      
Bralen
on 12/13/11 8:08 am
I have Anthem Blue Cross. My PCP told me that they will cover a tummy tuck and breast lift if I choose to have it. The way it works with my insurance is that the decision is up to my medical group and they would need to give me a referral to a plastic surgeon within my network.
Start weight 263     Surgery weight 247  
ckrtom2
on 10/1/13 12:06 pm

I have lost a great deal of weight through diet. I have been maintaining the loss for a few years. I have massive excess skin everywhere, but no rashes or other issues. I have no doctor, no insurance at all. 

Due to Obama's Affordable Care Act, I am now shopping for insurance. They say they cannot deny you for preexisting conditions. Does anyone know of health insurance companies that will cover my skin removal or have any suggestions...?

 

jeterway
on 10/1/13 12:13 pm
My guess would be if it is not causing rashes and infections or pain of any kind, it will not be covered.