PLASTIC SURGERY QUESTION!!

 hey everyone!! 115lbs lost.. feeling great!! hope all of you are doing great as well. BUT heres my problem.. excess skin.. i am getting terrible rashes all the time.. i have terrible back pain from my breasts now. has anyone gotten plastic surgery covered under their insurance for medical purposes. i go to see my primary in a few weeks to see if we can do anything.. let me know if uve gone thru this as well.. thanks!!

Shayna

 Shayna.....most insurance companies won't cover PS due to the fact that they view is as cosmetic.    You could be one of the lucky ones though.    I had constant back pain due to the skin pulling on my body.    I ended up paying for my LBL myself.   Good luck to you and I hope you get your PS covered.


Hugs and blessings ~~~ Vivian

 Document, document, document!!!! Many insurance companies will cover the tummy stuff but not the breast even with it but it doesn't hurt to try. You never know. 

Going to the doctor is the first step. Make sure that they add a note to your chart about the rash as well as the pain. Be very specific in where the pain is. If you get a prescription - fill it. Attempts to resolve the rash without surgery is important. If it comes back, you go back to the doctor. The more you go and have problems, the more likely you will get something covered. 

I have not had surgery yet, but I can tell you that I am worried about excess skin as well so I started looking into my insurance policy. It specifically states it will pay for a tummy tuck or panniculectomy...BUT only if it is deemed medically needed AND all other non-surgical attempts have failed. So, even though I can't really give you much advice, I can say to really look into your insurance policy. If it isn't covered, then you probably won't have a chance. But if it is covered, you will need to make all the attempts to fix the problem without surgery, so many many visits to your PCP. Hope that helps, and good luck! I'm hoping to get my surgery and then start that battle for plastics down the road

beautiful profile photo

Congrats on the weightloss what a wonderful accomplishment. If you have Kaiser or HSMA it is covered if you complain about pain the excess skin is giving you. I have not had it done but many in our program have. Just be careful if they tell you what doctor to go to. At Kaiser you do not have a choice and we have had people have bad expierences. We had one lady go private and pay and she really liked her outcome but it was super expensive. Good luck on your journey

I'm currently trying to get approval for  a pannulicutomy.  I was told by the scheduling person that most insurance companies wouldn't pay.  She finally looked at my profile, medical history, and pictures and is putting it through for approval because of medical reasons such as skin rashes, lower back pain, and a contributing factor for me developing hernias (I've had 2 hernia surgeries 8 months apart- - most recent was Aoril 18). Good Luck!

Hi Shayna

I second the poster's recommendation to "document, document, document"!  Save receipts from all your prescriptions AND over-the-counter medications you purchase for the rashes.  If  you haven't tried any of them, get them now.  The generic versions are fine.

Be sure to visit your PCP at least twice!  Have someone (I had my WLS's nurse take mine) take pictures of your rash (at it's worst).

Ask your WLS and your PCP to submit a letter (and especially your WLS's advice on how to best submit).  Include those two letters, your prescription/OTC receipts, etc., the pictures, and a letter from YOU stating how the rash effects your life.  (I also researched the negatives about using cream medications long-term, and believe me you would be shocked to find out what they are!).  I included all these in a packet that my surgeon (my WLS also did my panniculectomy) submitted to my insurance company.

Best of luck to you,
   Sandie

It can be done...but it really depends on your insurance company. Contact them and get specifics.

I have been approved for belly, breasts and arms.

First time thru- no probs at all.

I have lost 163 punds. My surgeries have been deemed reconstructive and medically necessary.

I had to endure having many many pics of me taken in a paper thong for submission to the insurance company. But it paid off...in a big way.

Surgery coming up Aug 8!!

First off, head over to the Plastic Surgery section of OH to get a lot of your questions answered.

Next, you need to check your insurance company's Clinical Policy Bulletins (usually found on-line with a search).  These will tell you what they will cover and the criteria you will need to meet.  then you need to check you actual policy and make sure it isn't excluded (some company's buy only 'buy' partial coverage plans). 

If they allow it - it will be labeled as only if medically necessary and not for cosmetic purposes.  The CPBs will tell you what they consider medically necessary.  Usually that the Panni has to hang to a certain area and is accompanied by continuous rashes for a certain numbers of months and be documented by visits to your PCP. 

Back pack and quality of life is usually NOT a factor they consider medically necessary for a Panniculectomy, but they usually are for a Breast Reduction.  But there are other considerations for Breast reductions as well.  You will have to look up the CPB for each issue.

I was initially denied for a Panniculectomy, but appealed based on rashes.  But that was because my PS didn't turn in all the documentation I had provided him.  Take pictures of your rashes, have your PCP take pics and document the visit with the proper diagnoses code (found on the CPB).  This will go along way towards helping you get your surgery approved on the first try.  And if they do deny it - file an appeal.  From what I understand, most insurance companies deny automatically at first - even with all the paperwork.  Not everyone gets through the appeals even with all the criteria met.

Hope this info helps and Good luck!!