Skin removal ?

tgrlnh
on 6/25/12 12:55 pm
RNY on 06/05/12
Has anyone with anthem been approved for Skin removal having it deemed medically necessary?  If so what were the pre req's?  I'm no where near ready for it but I'm just looking to the future.

HW 351 SW 314 CW 140 ~ Surgery Day 6/5/12 - The first day of the rest of my life!

Cicerogirl, The PhD
Version

on 6/25/12 1:04 pm - OH
The are quite a few people he's who have had panniculectomies covered by insurance.  That only includes removal of he skin bel he belly button and does NOT include muscle tightening.  often people end up having a full tummy tuck afterward, because it can look very odd if the flat lower belly is topped by lots of extra skin at and above the waist.

Usually insurance requires that the excess skin hang down below the pubic bone and that you have X number of months (for mine, it was 6 months) of documentation of rashes and other skin issues that have not responded to topical treatment.  So you need to have your PCP document any problems you have and document what you try to use to eliminate the rashes.  Some insurance companies require photos of the skin issues.

It is very rare for insurance to cover other types of excess skin removal.

Lora

14 years out; 190 pounds lost, 165 pound loss maintained

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

tgrlnh
on 6/25/12 1:32 pm
RNY on 06/05/12
Thanks Lora, I was only really asking about the skin on my lower abdomen because it is already becomming a problem with dermatitis. 

HW 351 SW 314 CW 140 ~ Surgery Day 6/5/12 - The first day of the rest of my life!

laura_vermont
on 6/25/12 8:39 pm
 I had an insurance covered panniculectomy.  I got "lucky" and had a hernia that was repaired with the muscle work and a generous plastic surgeon *****located my navel.  I'm very happy with the results.  

I'm in the process of trying to get the buttock area approved.  My PCP is surprisingly positive about my chances and I have an appointment with the plastic surgeon on 7/19.  I have cracking skin back yonder and according to my PCP, the infection risk is very high.  I'm crossing everything for this approval because the split skin is quite painful, especially with sweating.

Good luck with getting approved!
Laura
High Weight 278; consult weight 234; Surgery Weight 219 Surgeon's Goal Weight 150 -10/27/10  -  Personal goal weight 140 - Achieved 12/11/10  
  
Mal
on 6/25/12 10:27 pm
 I had a pannilectomy covered by insurance prior to wls (I had twins, then triplets and was left with an enormous panni with lots of skin infections that were documented).  I am going for a Lower Body Lift consult soon with a ps that is covered by my insurance.  It is all in the way the PS words the letter/photos to the insurance company.  It must say RECONSTRUCTIVE surgery (in my case it is I lost 170 lbs and am left with a bottom/thighs that look like a sharpei puppy).  In the summer heat I am starting to notice the skin folds becoming irritated.  My skin on my back end area is so bad i can litterally pick it up by handfulls and pull it out about 10 inches.  Hopefully I get it covered.  If I don't then in the winter when I get my income taxes back I'm going to self-pay but everyone seems to think that I have a good chance of it getting covered.

Mallisa
                
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