Question:
How is NGS coverage for abdominoplasty/panni ?
I am wondering if anyone has had any experience with getting approval for an abdominoplasty/panni? Was it hard to get coverage for reconstructive surgery? Do they require alot of documentation? I'd appreciate any info! — DeeAnn (posted on September 30, 2004)
September 30, 2004
I am currently trying to get insurance approval. I work for Mayo Clinic,
they self-insur. I have been denied twice. I just sent in my request for
a level 2 appeal. The criteria that Mayo's insurance has set up are so
ridiculous that no one is likely to ever meet them. Rather than say they
won't cover the surgery, they've made the criteria unreachable. I did have
a Mayo Clinic plastic surgeon put in the request. He has told them that he
feels this surgery is medically necessary but they are still not approving.
— Kelly H.
September 30, 2004
Skin removal is considered cosmetic not reconstructive surgery by the
insurance companies. Your doctors (primary and surgeon) need to be
documenting that you are having physical problems because of the extra
skin. Also, insurance companys require you to be post op for at least
(min.) 1 yr to 18 months and be at a stable weight for 4 to 6 months before
they even consider you for surgery. You should be at your goal and hold
that goal for at least 4 to 6 months. If you are still losing they don't
want to have to do the surgery again. Also, expect to pay some out of
pocket monies. I have a surgery date for Dec 10th (butt, thigh and arm
lift). Insurance is covering a basic butt and thigh but I need more
extensive so that is going to cost me 4,000 and my arms are not covered so
tha is 2,500. Grand total out of pocket 6,500. Most PS require that you
pay that money upfront before the surgery. Some work with a financial
company so you can take out a loan. The doctors that do the BY Pass
surgery need to start explaining that SKIN REMOVAL may not be covered by
insurance so you need to plan accordingly. I was willing to live with my
excess skin but I was having problems sitting do to the extra skin. I can
sit for more that 1/2 because of the pain. I wish you luck. In the
meantime keep exercising. This way when you do have your surgery you will
have more toned muscle and they won't have to do as much skin removal.
EXERCISE is very important. It will not make all the excess skin go away
but it will help you in the long run. Again, Good Luck. I hope you are
approved.
— Linda R.
September 30, 2004
I got to goal within 7 months or so and had pannilectomy w hernia repair
less than 8 mths from my wls date,I weighed 133 pds going in.Not all
doctors require you to wait a year if your very close to goal and have
hernia or other documented problems.Also my weight was not stable for six
months I lost ten pds the month before and after my plastic surgery.Both my
weight loss surgeon and plastic surgeon recommended surgery .I lost a total
of nine pds since my tt and seem to be leveling off at 122 pds.I advise you
to seek individual consult based on your personalized needs.Good luck!
— glori74
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