Body contouring rare after weight loss surgery

Yeah -- it's .... ALOT.

And thanks.  It happens sometimes.  But I thank you -- the positive outweighs the ... crazy.

In most of the country, medical necessity for insurance coverage is required.  But NOT in California, if you have a health plan covered by the CA Dept. of Insurance or Dept. of Managed Health Care.

You might be interested to read the results of the Utilization Revew #7 in this document - this is one of the first of the reviews of CA insurers that are going to get this type of analysis - don't ask me how I know.

http://dmhc.ca.gov/library/reports/med_survey/surveys/126fol lowup070511.pdf starting on page 11 of the .pdf.

That was way to technical for my friday addled brain, could you help me understand? Would something like San Jose Kaiser cover plastics?

Here's the deal: SoCal and NorCal Kaisers have PS practices - but they are almost exclusively for cash pay, and accept patients both inside and outside of Kaiser.  They rarely acknowledge that a Kaiser patient qualifies for coverage, and then only if medically necessary.  And of course, THEY make that determination themselves.

But there is a statute in CA that requires insurance companies in CA that are covered under it (if the plan was "delivered in CA" or something like that - it covers most but not all fully-funded plans in CA) to cover reconstructive surgery if the patient has an "abnormal structure of the body ... caused by a disease (and the fact that morbid obesity is a disease has already been litigated by the DMHC) .. for which reconstructive surgery can EITHER (1) improve function OR (2) improve appearance, to the extent possible, and that improvement is more than minimal [thus excluding mere cosmetic improvement], then insurance coverage is mandated.

The document I directed you to was a corrective action taken by the DMHC against UHC for failing to apply the correct standards in reviewing requests for reconstructive surgery.  It details the legal standards that must be met, and which the DMHC will apply if patients file a complaint for improper denials of coverage.

However, Kaiser is an interesting situation.  In order to get your case to the DMHC in good order, you need a letter from a reconstructive surgeon saying and supporting with evidence that you have abnormal structures of the body, caused by a disease, etc.  But you aren't going to get THAT letter from the PSs at Kaiser, and if you go outside of Kaiser and self pay for a consult, the outside PS KNOWS that if his letter is successful, you are STILL going to have PS with your (now pissed off, of course) Kaiser PS.  So what's in it for him (the outside PS) to write a good letter??

I will send you a PM regarding one option you might have, that might be good not only for you, but for a LOT of others similarly situated.

I have been working with a class action law firm in CA for several years on a similar case against another insurance company.  There is another suit against a different company pending as well (this is in the public record).  One of the attorneys mentioned to me that they are preparing yet another case against Kaiser, and are looking for representative plaintiffs for the case, i.e., to force Kaiser to follow the CA law for coverage of reconstructive surgery. 

I'm sure the attorney would like to talk to you.  She would probably want to discuss helping you with your submission for coverage, to get a denial from Kaiser and set it up for their suit.  And they have an outside plastic surgeon, Katzen, lined up to do the outside consults.

Here is the contact info - tell her I sent you:

Lotte ColbertGIANELLI & MORRIS626 Wilshire Boulevard, Suite 800Los Angeles, California 90017213.489.1600;  Facsimile:  213.489.1611[email protected]

I am becoming more and more aware of the likelyhood that in order to trully have a "normal" body and life, I will need to get the plastics done.  I hope I can find a way to pay for it, hopefully in some part by the insurance company.  Either way, I feel that I am worth the investment.  Even if it were $20,000.  I expect to live for another 40 years, God willing more.  Having plastics done will be a benefit to me for the rest of my life and it seems like a bargin for $500/year.

I guess it dpends on how you define "rare". My surgeon says somewhere between 20% and 30% of his patients go on to have plastic surgery. I'm not sure if that qualifies as rare but it's definitely not the majority of WLS patients. It's a much smaller number than I would have guessed.

Here is my own situation:

-my loose skin is not "that bad." I get no rashes, I have a smaller panus than my insurance company will pay to remove. My arms look like a lot of people's 'after PS' pix.

-my loose skin does interfere with life sometimes, mostly when bike riding

-my loose skin drives me crazy at times, especially the arms and the face

Yet, I am 3 years out and I haven't done anything towards getting PS besides going to some free consultations at WLS conferences. Why?

-PS is a riskier surgery than WLS and that scares me

-My issues are largely cosmetic and, while I don't discount the psychological aspects, I am not normally a person who cares about the cosmetic.

-There are so many other things I want/need to spend my money on.

That said, I have decided that I am getting it once my car loan is paid off. I have told the part of me that thinks it's shallow to bug off and I'm ignoring the other things I want to spend my money on too.

I'm sitting here just two days out from round 2 of plastics. Round one happened last year. The cost is definitely huge. For me to have this opportunity, I went back into the work field, worked and saved for 2 years to be able to afford to do this. The pain is quite a bit, but I will say, for me it was the "final step" in my weight loss journey. For the 1st time in my life (well, since I was 6 years old), I don't have belly hanging over anything.

 Grats  Roo !  I miss ya gal!   :)  Heal fast , be well  & God Bless!