Trying to Find the Right Surgeon for Plastic Surgery After Weight Loss

Okay, so I have lost a lot of weight over the last year and of course, like so many, have some excess skin, though not much, that i just need to have removed.

I cannot wear a bra. I have to wear a sports bra sized small or medium for support when working out or under my clothes because regular bras just are NOT working for me. However, even with the sports bras I get rashes and stuff. I have been to my PCP and a dermatologist. My PCP even gave me a referral for a plastic surgeon.

I don't need any major work done as the problem areas are just my stomach area and breasts (sorry to any men about the bluntness, but I am looking for help). 

I went to visit a plastic surgeon on Friday and the meeting was good and he was impressed with losing 140 pounds that I did not have a lot of excess skin. As I mentioned, he also told me that the same two areas seemed to be the only issue. So, in walks the office manager, and she just flat out tells me that my insurances won't cover the surgery, even with the referral from my doctor and the complications I described, and the medicines that had been prescribed. She did give me a pamphlet for some CareCredit program, which I don't want another loan. I have a car loan and student loans - that is enough on the loans.

I work two jobs and have Aetna and United Healthcare. I had no problem being approved to have my gastric bypass (RNY) at all...the process went very, very smoothly. I was just astonished that the office manager would tell me that without even submitting any paperwork to my insurance company. To me, as I have learned throughout my professional and educational experiences, it is all in how you say/write things up. So, that they did not even try - I am just very disheartened. 

I also can't keep going from surgeon to surgeon and having all these people keep submitting to my insurance companies - i just don't think that would look good.

So, I decided to post here and ask if any of you that have had any surgery done or know of someone who has had it done, has any recommendations for a plastic surgeon with a high insurance approval/authorization rating for weight loss patients needing skin removal? I am hoping this question makes sense and look forward to your responses.

You need to read your insurance coverage docs yourself, or call your ins co.  I have been looking my coverage over and my policy said the the skin must hang below the level of the pubis.  I am not sure exactly how low that is, so I am having a consult with a PS to get his opinion on if I will be covered. It also states that you must be at  a stable weight for  6 mths and have medical or mental problems with the skin.  I know breast revision is not covered by my plan but pani is under some cir****tances.  Research it yourself then try another surgeons office it you think the first one was wrong.  Good luck those insurance documents are confusing and they try to avoid paying.

edited to add:  you may want to try an intern program.  They are about half the cost.  If my insurance doesnt cover my pani, I am planning on going to Baylor college of medicine.  Here is the contact info I have for them if you are interested.  I heard about them on the plastic surgery forum.  They gave me an estimate of $1500 surgical fees and 3900 hospital and anestisa for TT.

Connie Pulido

1977 Butler Boulevard, Suite E6.100

Houston, Tx. 77030

713-798-8074

713-798-5014  fax

BCM

Good Luck, I highly doubt cosmetic surgery will be covered, unless you are getting breast reduction surgery but you can keep trying.  Why not check with your insurance yourself. I paid for my plastics myself, they were cosmetic to make me happy nothing more, I never even tried getting approval.  I did use a residency program to keep the cost down, Yale, here in Connecticut.

Although it seems as if the office person was kind of rude, i can absolutely understand why they didnt even TRY to submit it for insurance approval.  They have done this hundreds of times and they knew it would be a waste of their time (and, therefore, money). In this situation, it is NOT just about how you write things up (unless, of course, you and/or your surgeon are willing to embellish/lie and commit insurance fraud). It is not the SURGEON who has the "high approval rate", it is the individual INSURANCE  plans.  Insurance companies (and the companies they insure) are being more and more stringent about making sure people meet the medical criteria for procedures.

I can tell you that Aetna will NOT cover a breast lift under ANY cir****tances because they do not consider rashes under the breast to be a medical condition since supporting the breasts off the ribcage as they should be will alleviate the problem.  They will only over a breast reduction  if there is 500g of breast tissue to remove from each breast (and based on your sports bra size, you definitely don't have anywhere near that much).  They also refuse to cover arm lifts, even with severe rashes and infections in the armpits.  I even appealed that one and my PCP sent yet ANOTHER letter indicating that he had no idea what to do to help me with it.

The only skin removal Aetna will generally cover is a panniculectomy, which is removal of skin below the belly button, and even then, they require evidence of rashes that did not respond to prescription powder/cream treatment AND if the extra skin hangs down over the top of your pubic bone (over where the pubic hair begins).

i have no idea about your other insurance,but most of them are the same.  Check the policy to see what it says about abdominoplasty and breast lift to see what they will cover and under what cir****tances. You will likely quickly find out why the PS's office wouldn't even try.

Getting approved for a gastric bypass which is truly needed for your health and well being is very different than trying to convince an insurance do pant that your boobs need to be perky and the skin on your tummy should be taut.  I knew that sounds harsh, but as someone who paid out of pocket for removal to LOTS of skin from arms, mons, and tummy (the only thing Aetna would cover was the panniculectomy), when the mons was huge and the armpit rashes were horrible, I would tell you that you will be better off spending your energy figuring out how to come up with the money yourself than trying to figure out how to convince insurance companies that you need surgeries they don't cover.

Lora

(Edited for typos and autocorrect errors)

I have Aetna also, and everything Lora said here is correct for my policy also.  Breast lifts, tummy tucks, and brachioplasties are not covered at all, even for reconstruction purposes, not cosmetic.  Panniculectomies can be covered, but my plan requires 3 months of documented medical issues and no response to prescription treatments.  The skin must also descend past the pubis, with photographic evidence for that to be covered.

 

If your insurance prohibits coverage of a type of surgery, no plea or explanation by your doctor will help.  Read your plans carefully.

I really, really appreciate your honesty and will review my policy. You were very thorough and helpful. I appreciate the directness.

I paid for all mine myself because it was cosmetic - I'd be VERY surprised if insurance paid for your boobs or panni if they're not that bad!!!

Start saving - it's what most of us do!

I agree with the others. A certain amount of tissue has to be removed for a breast reduction. All I had left was skin. Most of us find a way to pay for it out of pocket.

Try http://wlsappeals.com/common-bariatric-denials/reconstructiv e-surgery/