Question:
Plastic Surgery- Have hernia, no rashes.. idea on approval?
Hernia? yes. Rash? no. Covered TT? OK I do have the hernia but I don't have any rashes under the extra skin. Any ideas on if I will be approved for reconstructive surgery to remove the hanging skin? I want it all, the boob, tummy, hip, thigh, and arm lifts. What should my chief (other than my friend, Hermie) complaint be, when I see a PS? — jocelyn (posted on July 12, 2003)
July 12, 2003
I have had mild to severe back and shoulder pain since losing 95 pounds--I
am trying to get the skin removal(note I didn't say TT) covered. Right now
I have a verbal approval and waiting for the letter. I went thru my PCP to
refered me to a back doctor, who then refered me to a plastic surgeon.
— barbara A.
July 13, 2003
You are very lucky not to have a rash. I am sure other conditions can help
you to get approved for TT as well, such as: shoulder back pain, your
hernia alone will help you to be approved, but mostly the amount of hanging
skin you have. What kind of insurance? That is the most important thing
from what I understand. I am in the process too and I have BC/BS federal
and as secondary BC/BS of Illinois. Anyone have any success with these two
insuraces? Although I have been documenting rashes for the past year with
my pcp and a dermatologist, I remember reading that someone on here got a
terrible rash from spraying hair spray in the apron area????? Don't know
if this was intentional or an accident but that is what I read. I don't
think it would be wise to do this intentionally because these rashes are
very uncomfortable and painful too. Good luck getting approved! Never
give up trying.
— Mylou52
July 13, 2003
Hi, My insurance BCBS HMO Blue will allow a TT not only due to rashes, but
if it affects you mobility, causes pain....I am sure you can come up with
some problems as a result of the skin...oops did I say that.......
— Kriola
July 13, 2003
I don't know about all insurance companies, but a hernia is not an instant
reason to get approval for a tummy tuck/abdominoplasty. The hernia can be
repaired (either laparoscopically or open) WITHOUT any tuck. The tuck will
make the area look better but the hernia repair does not in any way alter
the area or necessitate reconstruction. I recently had an open hernia
repair/full abdominoplasty. I had to get the procedure done this summer
because I go back to school in September. So, I didn't even try to go
through an appeal. I applied for a tummy tuck/breast reduction at one year
post-op and was immediately denied. My PS said there was NO WAY my
insurance (GHI) would approve of a tummy tuck in my case. My tummy did not
even go over my pubis. I had extra skin but it really wasn't apparent when
standing. So, I didn't even apply for approval (my PS would not even
apply). I was initially quite upset about this but upon meeting others, I
knew that approval was not something that I could expect. I'm not sure if
I would have been able to finally get approval with appeals, etc. Somehow
I think not because my belly really, really, really wasn't that large. I
never even thought I'd get any plastic surgery done because my skin wasn't
that excessive. So, the hernia gave me an opportunity get the tummy fixed!
I paid a surgeon's fee (5K - this is pretty common for NYC and Dr. Karp is
one of the Top 200 surgeons) and will part part of the OR time and
anesthesia. A tummy tuck alone would cost about 15k, so having the hernia
repaired along with it (this was approved and hospital stay included)
really reduced the cost considerably. I think if you have an extensive
pannus, have documented problems, fight, fight, fight! But, really, if
your pannus is not extensive - I don't see how you will get covered.
You'll have to decide whether you think it's worth it to pay some out of
pocket (much less than if you did it alone). I am very glad I did it...
only 5 days post-op and feeling tight, tight, tight! I'm overjoyed that I
was able to get this tuck... I never thought I'd be able to afford it and
it wasn't bad enough that I really, really needed it. I wish it were much
easier for those post-ops who really need reconstruction to get their
bodies back! I am grateful that my skin really bounced back and I don't
'need' any PS.. but the flip side of that is if you do want to get
something done, there's a chance in hell that you'll get any reimbursement
for it! I wanted to tighten my stomach muscles. They were totally shot.
That was my first reason to get an abdominoplasty. The second was to
remove the bulge I had on my tummy. I also HAD to get rid of the
incrasingly HUGE incisional hernia that was growing like an alien above my
belly button! All the best to everyone, (preop: 307 lbs/bmi 43 now:
160ish/bmi 23ish/ 5'10")
— Teresa N.
July 13, 2003
The hernia is a start from my understanding. Anthem should pay for it, even
if no rash. Are you having back problems? That could be from the need for a
breast lift. The arms are a little harder to have done, but i'm sure if you
sent in pics showing the amount of hanging skin, that would make it easier
- Actually pics included in any reconstructive surgery is to your advantage
especially if the problem is severe. I also plan to document throughly any
problems I have with excess skin (which I'm sure will be fairly severe,
unfortunately) Good luck and much success!! Robin
— Robin J.
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