Help with surgery questions/Medicare approval

kbowman2
on 3/3/12 5:08 am
I thought I'd just be happy with the 220 pounds I lost but this excess skin is really affecting my mental well being and my own self image. I am embarrased to be naked in front of my partner of 16 years even though I wasn't embarrassed at almost 400 lbs. After seeing my skin float in a jacuzzi tub on a lovers weekend recently I think I've finally made my mind up that I don't want to live with this skin and have to hide myself all year round.
Have any of you had surgery approved through Medicare? What hoops did you have to jump through? I do have a short record of skin rashes documented with my PCP but I don't think this will be enough. I need help. Where do I begin?  Is there a surgeon in my area (Northern Delaware) you could recommend? Do plastics surgeons care about helping you get approved through Medicare? Will my surgeon help me?  I need it all.  My arms, thighs, boobs and entire tummy/butt needs serious intervention.
Any suggestions, help, support, whatever you could give me I'd greatly appreciate.  I am so scared of the pain after surgery but I can't let the way I look naked ruin my self esteem every time I take my clothes off.  I don't want to live feeling so terrible about myself.
Help. Please.

Thanks,

Kim
Heaviest 397/ Before Surgery 367/ Lowest 170/ Current 185
      

JUDY C.
on 3/4/12 6:47 am - Bear, DE
Hi Kim!

From what I understand for Delaware, Medicare is pretty easy to get your Panni removal approved.  The arms, boobs and thighs I don't have any information on.
I have private insurance and did not use Medicare but my friend went through the approval process like it was nothing.  I had my work done by Dr. Julia MacRae.  She works with 2 other PS.  I hear that Dr. Saunders does pretty good work.  You could check them out.  No consult fee like some doctors have.
You need to have your PCP and Dr. Peters write a letter about the rashes.
Below is there website

http://www.christianacosmeticsurgery.com/

Good luck and great job on the weight loss!

(I don't know if you attend the support group at Christiana Hosp. but occasionally Dr. MacRae does a presentation)

Judy

                    
             ~Believe in Yourself~

Cherish F.
on 3/5/12 12:44 am - Philadelphia, PA
Hi sweet pea!!
First - you're beautiful! Always have been, always will be.
Second - I totally get it.

I know nothing about Medicare. The only suggestion I have for you is to find a plastic surgeon and go in for a consult.
Give him/her your wishlist and have them submit. This is basically what I did. I contacted both my breast care doctor and my gastric doctor and asked for recommendations. They both highly recommended the ps that I ended up with. Who thankfully was in my "network".

At my consult I basically said I wanted a breast lift/reductions and if she thought it was worth trying a panni and/or tummy tuck. She took a bunch of pics and had me get a letter from my PCP with a short explanation of my history and everything we've tried. That's all she asked for to submit.

Now, at first they denied everything. But she arranged a "peer to peer" phone call with the insurance rep, and basically pled my case.

Within 24 hours I was denied, reviewed, and then approved for the breast reduction. I knew going in that my panni area wasn't "bad enough" by my insurance standards, so wasn't surprised to be denied on that. I worked out a deal with my ps and am going to pay for the tummy tuck out of pocket while the insurance is paying for the operating room for the breast lift.

Remember, surgeons WANT your business. They have every reason to guide you through the process and fight on your behalf. Let them. Even if they submit and get denied, it may come with a that request for more info/pics/treatment, whatever. Then you have a point to work from.

We can talk more when I see you Saturday. And I will try to find a copy of what my PCP wrote. It's awesome. A mix of truth and fiction that worked.


 Cherish
Consult Weight/ Surgery Weight/Current Weight/  Goal Weight, Reached 4/7/11!!
     294                     286.5                     165.5                     164

Full abdominoplasty & Breast Reduction/Lift - 4/9/12!

Even miracles take a little time. ~ Cinderella

                
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