Medicare and panni

My name is Ruby. I had the DS in 2010. I have lost 158lbs. My surgeon's PA estimates I have  25 to 30lbs of skin around my mid section. I have medicare. I am having skin break down recently and back pain to the point of tingling and numbness. She wants me to start getting documentation as soon as I get back home. I traveled out of state to have surgery and just had my 2 year so I'm still in Indiana. I was wondering if anyone knows how long, how often I will need to do the documentation for medicare to consider a panni medically necessary? I will go as much and as often as needed. I was also wondering if there were other things I could do to help with this process. I have heard that pictures of the breakdown would be good. This I can do. I'm in theropy every other week. Should I have her document stuff also? I have some money I could add to what Medicare covers and have an acutal tummy tuck, which would be awesome. If I have to pay full price out of pocket it will be years before I save enough. My PA has given me hope that this may be able to happen for me in the near future. I just want to do all I can to ensure that this happens. Any and all advice and/or help is greatly appreciated!!

Ruby

I am not sure about Medicare specifically, but many insurance companies usually ask for 3-6 months of documented rashes that have not responded to treatment. It would probably help to go to your primary care doctor and have him or her document the rashes and any treatment used for them.

I’m not sure how far you are willing to travel, but I met with two plastic surgeons in Cincinnati that take insurance payment for a panniculectomy and were willing to do the additional work for a tummy tuck at no extra cost.  I don’t know if they take Medicare, but I can pass their information on to you if you are interested. 

Very interested actually! Thank you for responding! Any info you have is greatly appreicated!
Ruby

I am starting to look at PS and live not far outside of Cincinnati - any chance you can forward on the information to me?

I had four consults in Cincinnati before I made my choice. The docs I met with were Kurtis Martin, Richard Williams at the Plastic Surgery Group (they have six surgeons there), Jennifer Butterfield, and Allison Lied.  All four doctors were wonderful and spent well over an hour with me for my consults. I would really recommend any of them.

Dr. Butterfield and Dr. Lied were willing to work with insurance for a panniculectomy/abdominoplasty. I decided to go with Dr. Lied because her plans for how to address my problem areas were most in line with my goals. She is also the doc that my bypass surgeon recommends and has given several seminars at our support group meeting. The fact that she would take insurance payment was a bonus, and I am having a lower body lift with her in about a week. I am paying the difference for thigh and butt lift and some lipo, but the whole surgery is less than $8,000.

Just let me know if you want any more info!

Thank you so much! I'm from the central Ohio area and I haven't been able to find anyone that I haven't felt like drive through surgery with. I'll do some checking and investigating. Thanks!

federal Medicare (as opposed to managed medicare programs) does not do predeterminations for surgery.  However, medicare rates for the procedure are so poor that most providers will not do a medicare panniculectomy alone as we'd be losing money given the complexity of the surgery and difficult aftercare. Your best chance is to expect to pay full freight for an abdominoplasty and have them file medicare for a panniculectomy and rebate you the balance if it's ultimately paid (~ $700-900)

Thank you!!