United Health Care Choice Plus/Plastic surgery coverage?

I have United Health Care Choice Plus. I will be having DS surgery coming up soon and I know after losing weight I will have to have tummy tuck and breast reduction. UHC will cover breast reduction no problem but will only cover tummy tuck if medically necessary. Has anyone with this insurance every got approved for tummy tuck and if so what steps did you have to take?

You need to find out how your insurance defines medical necessity and then what I call back into that definition.  Generally the insurance company wants documented evidence that the excess skin is making you ill.  Rashes in the skin folds, yeast infections that sort of thing.  Some will also accept back pain.  Some also require that the panni extend past the pubic bone.  My best advice would be to NEVER self treat any rashes.  You will want to see your PCP or dermatologist every time you get a rash.  You want to document something on the order of persistent skin issues that is unresponsive to less invasive treatment.  Some people sail through the approval process for plastics.  Others cannot get anything done in spite of having severe issues.   It all depends on the coverage you have and if you fit (and have documented)  their criteria of medical necessity. 

You might want to post this on the plastics forum.  Also Dr. LoMonaco (Big Medicine) wrote an article on getting plastics covered.  The article starts on page 5.  http://www.drlomonaco.com/files/NeWeigh_2005.pdf

Red

Thanks Redhaired I read the article it was helpful. I have always had a large stomach even before having two babies and two c-sections. I have never had a any issues with rashes but I do have back pain. I am 5"3 263pds I wear a 40DD bra and carry my weight in my midsection. I look like I am about 6 months pregnant I have resorted to wearing a jacket everyday. I know once I have lost weight even with exercising I will never be able to lose that belly fat without surgery Dr Chua also does tummy tucks no breast though. I would like to have my surgery done by a plastic surgeon with experience with people of color because we have issues with hyperpigmention and keloids. I am calling my issurance and get some more information on what is medically necessary.

I have united health care choice plus and I looked online at my insurance coverage and it specificaally excludes panni removal as it is considered with all other plastic surgeries to be purely cosmetic. They did cover my DS itself without any problems.. So I guess I have to figure out what will I do with all my excess skin... as paying for it to be fixed out of pocket isnt an option right now.

Ami

Don't forget about the resident training programs that offer reduced cost surgeries.  I understand Baylor has a really good program.

Is this Baylor hospital in tx and what is DS?

We just had an insurance change in July to UHC, choice plus. My surgeon told me "you won't get this covered by insurance...it's just not gonna happen.". With that being said, my panni is so "small" that my surgeon is confident that he could do it outpatient and that it will be the smallest removal he's ever done. For me, it seems huge...but in the grand scheme of WLS and panni removal, it probably is small. Some surgeons will really fight insurances for you if your panni is big enough so I think that might be a judgement call. However, a fair warning...from my surgeon's perspective, UHC simply wouldn't listen to it.
Also, as far as breast reduction...
many DSers lose their breasts with weight loss. Its a common "my only complaint". For me, I went from a DD to a D so I didn't lose much. I haven't looked into UHC and reduction as my panni was much more of a concern for me. IF I do decide to do a reduction, it will certainly be more for "lift purposes" than reduction.
Good luck!

You might also find that with the weight loss your breasts will lose tremendous volume, like mine did. I started out as a DD and ended up a C and it was loose skin. I had very little actual breast volume left. I would have never qualified for a reduction because most insurance companies require that a certain amount of tissue be removed. You just don't know until the weight is off what you will end up with.

How long did it take for you to lose it? And what is DS? Ty

What did you have done to your hips and butt and how big was your panni? Ty