Question:
So many people have arm lifts, lower body lifts...is insurance paying??
I read so much about all the work post-ops are having. I'm 9 months post-op, down 121 pounds, and my arms, boobs and tummy need help! I can see where a TT would be covered by insurance, but has anyone had an arm or breast lift paid for by insurance?? If so, under what circumstances? — Angie M. (posted on April 19, 2004)
April 19, 2004
Angie...to get insurance to pay for plastic surgery you MUST document the
need. keep list of rashes in skin folds,mobility problems,shoulder or neck
pain, depression and altered body image. can also list problems with
finding clothes that fit properly and how that effects your body image and
self esteem. most plastic surgeons want you to be within 15-20 pounds of
goal before getting surgery done. more than 20 pound weight loss can result
in more sagging skin.Good luck!
— dianne E.
April 19, 2004
Good question, I was wondering about this myself.
Who does this have to be documented with? The PC or the PCP?
— Marie F.
April 19, 2004
Insurance paid for my lower body lift. I had photos of all the rashes
under my panni and inbetween my thighs. I had a paper trail of these
rashes and backaches with my PCP. Also had a printout of all the
prescription ointments/powders I used for these rashes to no avail. PCP
wrote a letter of medical necessity to the insurance company and they
referred me to a surgeon and paid in entirety for the lower body lift.
They flat-out denied the breast lift and arm lift so that was self-pay of
$11,000. The results are phenomenal and worth every penny.
— Vicki S.
April 20, 2004
My insurance paid for the panniculectomy and I added on the rest.
— mom2jtx3
April 20, 2004
I'm with Gina on this! It is often very frustrating for my patients, my
coordinators, and me to "jump through the hoops" and end up
denied. Linda's post sums up what I think everybody must face. Some may
be covered, but count on out-of-pocket for the rest. The reason is the
65,000 bariatric procedures covered in 2002 will be replaced this year by
over 145,000 cases (Am Society of Bariatric Surgery stats) There is no way
the insurance companies can deal with the deluge, and they will have to
require strict medical guidlines to approve the surgery. Add to the fact
that Blue Cross Blue Shield is investigating $50 billion in questionable
claims! Like everything else, it's about the money. All we can do is
document the problems, and stick with the companies when we beleive there
is a legitimate medical problem. The "cosmetic vs reconstructive"
argument is a thing of the past. We all know this is not vanity surgery. I
try and use my past experience and always give my patients an honest
assessment of their chances for approval, so they can plan for any out of
pocket expenses.
— DrL
April 22, 2004
If you have a 20 lbs. panni hanging down to your knees with extensive
documentation of rashes and back pain, you may be okay. Otherwise, prepare
to either live with it or go into serious debt to pay for it yourself. I
have yet to find a plastic surgeon who would even TRY to get mine covered
by insurance.
The fashion forcast for this summer - capri pants and loose-fitting 3/4
length sleeves...
— ediecat
April 22, 2004
I was approved by my ins. company last summer for a panniculectomy, they
denied the breast lift as cosmetic. My panni doesn't hang to my knees, it
doesn't even completely cover my pubic area and I've never had a rash. The
surgoen took photos sent them in and I was approved. Now that was just for
excess skin and fat removal, not a full tummy tuck with muscle work and
all, but hey, I'll take what I can get. Have not had it done yet, I found
out I was pregnant as we were setting up a surgery date, but maybe this
summer....
— Ali M
April 22, 2004
Actually you don't have to have a 20# panni hanging to the knees..I got
mine completely covered by insurance and my doctor removed 8# of tissue at
my panni with an addominalplasty and liposuction. I did have a hernia
repaired, so that probably helped. I also had a lot of back/hip pain with
documented perscriptions for pain relief. Another thing to remember is if
you have back/hip pain that we WLS patients cannot take NSAIDS for pain
relief and that is a good cause to plead with the insurance companies..good
luck
— Carolyn G.
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