plastics consult

went for a consult yesterday for a tt...bad news though the doctor doesnt think my insurance will cover any of it as my stomach doesnt hang down far enough...wth...couldnt believe that and of course i do not have a hernia and only use otc meds for infections...doesnt seem quite fair

What doesn't seem fair?

It sounds as though you do not have a medical necessity for plastic surgery but you want it.

Many of us are in the same situation ---- so, we make other plans.  We save or borrow to afford to have the surgery we want.

You can still have a tummy tuck, you will just have to figure out a way to finance it.

You can try to get your insurance to pay. Some pay more easily than others. If they won't cover it, you can live with your tummy as is or pay for it yourself. You can use your savings, get a loan, start saving now, or if you have bad credit, start doing everything you can now to repair your credit so you can get a loan later. Lots of us self-pay.

Laura

Here's something to consider, how big is your resolve? When I requested VSG with BCBS in the SW Region 2 years ago I was denied. I wrote a 17 page appeal with 55 references showing without a doubt that the sleeve wasn't investigational or experimental as. They claimed and their Bariatric policies referenced were so out dated ridiculous is not a strong enough word. I was denied again. My 2nd appeal I sent also by certified mail with return confirmation receipt request, contained some additions but was basically the same as my first appeal. I called every day, they told me I could have a Bypass from the get go (Gold Standard) during one of the calls I told the Branch Head that I hope you deny me again which will exhaust my requirements for adverse determinations.I told them I was so eagerly desiring to litigate the matter that was effecting thousands of other obese individuals. They had agreed on medical necessity, but wanted to dictate procedures. I was very serious in everything I said. I was approved for VSG and their Bariatric policy was rewritten including VSG as a viable procedure. The good part was during my appeal fight I loss 114 lbs on the pre diet and was in great physical shape. Still had the procedure and loss another 35 lbs to get to about 8% body fat. When I built a case record with my PCP of unimproved irritations/ulcerations of the excess skim folds. I was denied on not hanging to the pubic area. I appealed on grounds of actual medical problems (in graphic detail) the obvious anatomical differences from individual to individual ex. variances in upper and lower torso and how arbitrary the pubic area was. I was approved for a panning. I went ahead and had a LBL and mediall thigh lift and am looking forward to asking for a case review with BCBS. This was not cosmetic. The ins. co. are going to almost always deny your request and hope you go away, because people normally do. It's your decision... but never for a second let yourself feel that they are doing you a favor. Keep your head up and move forward. You decide what that means for you. Best Wishes.

Steve

i knew going in obviously they werent going to pay for a tummy tuck. but i think to be denied because it doesnt hang down far enough is frankly stupid. i am very meticolous with my skin care so i do use otc powders to control any infections. so i will pay for the tummy tuck because it does bother me. and my arms will be next...it will be a while as ill have to save up for that, can only afford 1 surgery a year. he actually gave me a pretty good price for the tt as a self pay so i should be able to swing that in 2012. believe im not really complaining about having to pay it totally out of pocket and i knew they wouldnt pay for a tt but i was hoping they would pay for the panniculectomy and id pay the difference. but since it prob wont turn out that way ill just pay it as my stomach area does bother me and that certainly is my choice, but i will fight the insurance company when they deny me

I think we have all learned through the past that insurance companies do what they want.  We need to just make a plan to do what we want also.  I had to pay cash for my LapBand.  Thankfully, I had the $9950.00 from a divorce and I didn't have to borrow it.  So 3 years later and down over 300lbs, they still refused to pay for any plastic surgery!  Believe me after losing that much weight, my panni hung down just above my knees.  I had chronic back pain and my knees kept popping out from the excess thigh skin.  Still they refused!  So I, once again, had to self pay!  It's life and unfortunately, life isn't always fair.  I am on the 5 year plan - I'm sure - as I save, I get my procedures done.  Not fun and not in my plan, but I am happy I am healthy and able bodied to work and earn and save.

Life goes on....

So proud of you, girly!! 

thats my plan...2012 will be my tt...then when i save the money ill get my arms done and then ill move on to the next body part...its not nec fair, but it is what it is

I decided to go to Dr Sauceda Monterrey Mexico to get my plastics done.  There really wasn't a way to fight Kaiser.  I did take a 401k loan out to get all my procedures done at one time with one recovery period.  It's like making a car payment every month, but I feel so much better about myself.  It was worth every penny.