First Consult Visit with Plastic Surgeon

Hey y'all!! Yesterday I did meet with the plastic surgeon my PCP referred me to and I don't particularly care for his attitude, and that's not just because I didn't get the answer I want. By the way, I am still losing weight!! I said I was a slow loser but for some reason my weight is melting off even better 2 years out. He came in and said get undressed and yeah well it's going to be hard to get your HMO to pay for a panni. I said well actually I wanted you to take a look at the breast also because they are super to severe. He says yeah well yes they are and you will be needing a lift with an implant, however the insurance is not going to want to approve the panni let alone the breast. So let's submit for the panni and see how that goes.

Now I am good with that, however I am thinking if the insurance will pay for the panni and it's major surgery and I have been thru 4 c-sections (not sure how they compare) wouldn't it just make since to maybe see if he will let me pay the difference for a full tummy tuck?

Still glad to have at least have gone to see that surgeon and now I am going to go to several different surgeons to see what type of estimates I can get and maybe start saving and planning for one surgery at a time starting with these "old lady boobs" as one of my male friends says!

Have a Happy Turkey Day everyone and don't eat too much!

Hi Papoose79

                      Good for you, go and make yourself beautiful and the world around you. God Bless.

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I don't know what insurance company you have, but please see the CA H&S code 1367.63, and how the DMHC is now applying it.  See the material starting on page 9 (it is for UHC, but the DMHC is supposed to be methodically reviewing all insurance companies' policies as they come up for their every-3rd-year review):

http://dmhc.ca.gov/library/reports/med_survey/surveys/126fol lowup070511.pdf

Your plastic surgeon needs to write a letter detailing how your excess skin meets the requirements of this law.  He needs to say, for example, that your breasts, post-massive weight loss, constitute abnormal structures of the body, caused by the disease of morbid obesity, for which reconstructive surgery can improve your appearance to the extent possible, and such improvement will be more than minimal.  He needs to say the same thing for each surgery you want.

If your surgeon won't do it, find another surgeon - the reason he won't do it is because if he writes the letter correctly and CA law-mandated coverage is approved, he will only get a "negotiated" rate of reimbursement from your insurance company, which is a fraction of the fee he can collect from you if you pay out-of-pocket.  Obviously, this is the wrong incentive, so you will have to watch him like a hawk - do NOT let him submit the letter without reviewing it yourself.

Having said that, you should NOT be considering reconstructive surgery if you are still losing weight - your weight loss should be finished and stable for 6 months at LEAST before you consider PS.  Since you have the VSG, you should consider waiting not only for your weight loss to stop, but also for any bounceback to settle in - otherwise, you are going to be going through pain and expense and risk for a suboptimal result.

Most surgeons will allow you to pay the difference between the panni and the TT.  My insurance denied me for all plastics so I paid cash.  I went to Mexico and have had 3 surgeries done.  I had consulted here in the states and the price was 3 x the price in Monterrey. 

If you can't get the insurance to pay, perhaps you could look for a surgery with a Resident program in the states or with Dr. Sauceda in Mexico.  Then you could get your breast lift/augmentation and TT all at once!