Weight Loss Surgery & Skin Removal

Aug 19, 2011

IF weight loss surgery is not covered by your insurance, if it is a direct exclusion...you will not get approved.  You can appeal, you will lose.  The only way weight loss surgery is covered by your insurance is IF your plan covers it.  It will be reviewed for medical necessity ONLY if your plan covers it.  It is NOT your insurance's fault if WLS is not covered...it is your employer group.  YOUR EMPLOYER CHOOSES THEIR MEDICAL COVERAGE.  The policy, with the weight loss rider MAY have too high of a premium and therefore, your employer may not elect to get that rider added to the policy.  IF your benefits have WLS listed as a direct exclusion...go to your benefits manager at your employer and advise them that you would like for them to consider adding the rider to their policy for next year.  I have been working for United Health Care for 12 years, I promise you that the insurance company is NOT excluding WLS because it costs too much or any other nonsense that you are told by your dr. or by your employer.  UHC covers WLS IF the employer chooses for them to cover WLS.    HOWEVER.....skin removal after weight loss surgery IS NOT COVERED BY 99% of all plans.  It is considered cosmetic and is therefore not covered.  There is direct verbiage that can be added to the policy to make skin removal covered but I have only seen 1 policy, the whole time I have been in appeals, that states that they will cover skin removal after gastric bypass.  That policy ONLY covered up to $3000. and then the rest was your responsibility, but, at least it was covered at some level.  YOU WILL HAVE EXCESS SKIN.  YOU WILL NEED TO HAVE SKIN REMOVAL SURGERY.  Be prepared for this cost somewhere down the line. It does not matter if you lost 10 lbs or 200 lbs....the skin removal is always considered cosmetic.  It doesn't matter if it is causing you pain, embarassment, it doesn't matter if it is sweating in the folds of your excess skin and causing bacteria or boils.....it is not covered.  The only way that skin removal of any sort is covered would be as reconstructive and the only way that it can be considered reconstructive vs. cosmetic is to prove that it is causing a functional impairment.  It is not covered if you say it's going to relieve neck or back pain as there is no proof that reduction of redundant skin results in pain relief.  It is not covered when it's performed in conjunction with another surgery such as hernia repair or hysterectomy, it is not covered for interigo.  MOST ALL PLANS consider any type of skin removal surgery cosmetic and your policy more than likely excludes cosmetic procedures.  That includes abdominoplasty, belt lipectomy,  lower body lift, panniculectomy,  brachioplasty and breast reconstructive after massive weight loss.   

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