Question:
Will Insurance Pay for Post-Op Plastic Surgery
I read the article in People that stated Carnie Wilson's insurance did NOT pay for her post-op plastic surgery. This really concerns me as I don't have $20K to plop down. Have any of you post-op's been able to get this covered by your insurance carriers? Thanks, Lora — LoraMullen (posted on June 20, 2002)
June 20, 2002
from what i have seen alot of insurances will pay for the panni-ectomy (for
lack of the proper name) which is the removal of the excess skin on the
stomach because it can cause hernias, back pain, lack of mobility... but
the others are out of pocket from what ive seen.. I did see one woman get
her thighs and back covered (trunkoplasty or something) but it took almost
a year of appeals with the insurance co and she started at over 500lbs and
ended up at like 150 or something and the excess skin kept getting infected
... so there were other medical reasons to appeal as well...
— Mary G.
June 20, 2002
Hi there Lora. I hope this is somewhat helpful to you...if not; forgive
me! I'm 9 months post-op and I've lost 177 lbs. At 7 months post-op I
was down 154 and I went to see a plastic surgeon. I supplied my plastic
surgeon with pictures of my rashes (one under the "mid drift" and
one in the "subpubic" area). I had my dermatologist fax a letter
to the plastic surgeon's office; I made copies of my 2 seperate RX's
(creams) and my plastic surgeon included pictures that he took of me in the
office. Well, it took a while for the dermatologist to dictate the
letter---but when she got it to the plastic surgeon, they faxed it in.
Almost 2 weeks ago I got my denial letter from Cigna HMO of FL. I don't
have my denial letter on me, but here's what it said...basically. It said
that the abdomenoplasty (sp?) was not covered because it was considered
cosmetic. It was considered cosmetic because there was no proof that I was
counseled on proper hyegine and that the creams failed, which I was, and
they did...but I haven't been in for a follow up yet. If I could prove
this, then they would consider it reconstructive--which is covered (but
does that mean they WILL cover it...I don't know! :o) Now, I should
tell you that I was informed that my arm lift would not be covered---so I
am saving up the almost $3000 for that. But, right now I'm in the process
of documenting my stomach rashes, any prescriptions, making appts. with my
dermatologist and PCP~ all in order to prove that these creams are not
working. I also have made it clear to all the Dr's that I see about this
problem, that this is for ins. approval purposes for an abdomenoplasty.
So, my suggestion to you would be to document with photos and a notebook
log (dates, how long they last, what RX's were prescribed---their effects,
if any) and start meeting with plastic surgeons as you get closer to the
time you would desire such a procedure. Keep RX reciepts...keep photos,
make sure that the DR's you see are willing to dictate letters documenting
your problems...and then beyond that, PRAY! I don't have 20G's to plop
down for the surgeries either---but you can still do your homework and
hopefully get desirable results! Good Luck!
— Kristin R.
June 20, 2002
Mine did - (extended Abdominoplasty - included panniculectomy). My PS took
pictures of me, submitted letter of Medical Necessity (the panniculus
seriously affected the "quality of my life") and it was approved
within days.
— Cathy J.
June 20, 2002
I had a panniculectomy and armlift done in November. My plastic surgeon
submitted frontal and profile photographs along with his letter of medical
necessity to both primary and secondary insurance providers. My secondary
insurance (Acordia) approved the surgery (including the armlift)
immediately, with no questions asked. The primary denied the surgery
forcing me into their appeals process. Since they already had the
photographs, I assembled a packet for the appeal which included a copy of
the plastic surgeon's original letter, letters of support from my PCP and
bariatric surgeon, a personal letter which outlined in detail all the
reasons that this RECONSTRUCTIVE (never use the word "cosmetic")
surgery was important to me, and a copy of the 1996 Position Paper from the
American Society of Plastic Surgeons entitled "Treatment of Skin
Redundancy Following Massive Weight Loss". My primary provider (CIGNA
PPO) approved both the panniculectomy and armlift surgery within two weeks
of the appeal. I wish you the same good luck!
— Diana T.
June 20, 2002
I just got approved this week for an abdominoplasty. I started out as a
"lightweight" but have lost almost 100 pounds. The insurance
company originally denied the abdominoplasty until they received the
pictures. That's what caused the approval of the procedure. One thing I
can tell you about the pictures, from the front and side views, it looked
like I had a problem, but not a severe one. However, my doctor made me
turn to the side, grab ahold of my stomach and pull it out as far as I
could and that CLEARLY showed how much excess skin I had. THAT picture I
believe got me the approval.
— Patty H.
June 20, 2002
As the others have said, the key is "medical necessity." Medical
necessity is deemed "reconstructive", NOT cosmetic.
— Leslie F.
June 20, 2002
I was approved for abdominoplasty and thigh lift after an appeal. I will
tell you what I included to get approved. I had a letter from my PCP
documenting treatment for rashes and back pain. I had a letter documenting
the same complaints from my RNY surgeon (just make sure he makes those
notes when you see him for follow up visits), I had a letter from my
psychiatrist that this excess skin was causing me pain, rashes, some sexual
disfunction, and depression. I had a letter from the plastic surgeon and
pictures. You will need to take pictures every time you have a rash if
possible. I would suggest that people start building this portfolio of
proof as soon as you have lost even 30 or 40 pounds. By the way, I had
surgery Oct.17, 2001 and started out at 265, I am down to 162. I am having
surgery July 1, and of course, I am a little nervous.
— cindy Q.
June 25, 2002
Thanks everyone for all the great answers. I haven't even had surgery yet
but I am trying to learn EVERYTHING I can before.
Thank you, thank you, thank you!
Lora
— LoraMullen
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