Question:
Blue Shield shot my thighs down twice now
I have come so far since Oct 31, 2001........from 420 lbs to 230 lbs a paniculectomy and an abdominoplasty......now my lovely Ins company is saying NO to the rest of my skin removals.......im in pain, re-curring rashs, yeast etc....we havent even gotten to the breasts and arms yet. What can a person do? Is the way the surgeon words the requests? What can I do? My emotional and psychological wellness are being affected by this — tonesangel (posted on June 7, 2006)
June 7, 2006
Hi Angela- just a thought- first of all congrats on your journey. We
doctors are not perfect- and sometimes we need to see what another
physician has written in referral form to get what is necessary for our
patients. Do you have pics of the problem areas, the rashes, the yeast
infections? I suggest one thing that might help, but its a long shot. I
would ask the ins co for a copy of a request from any physician who
requested plastic surgery, the most they can do is deny the request,
however they just might come thru for you and either fax or send you a
template of what they require. Its worth a shot. I wouldn't give up,
thats for sure. I have come down from 380 to 174 since march 2004, and know
i need hernia repair, and my batwings need surgery, but know if the PCP who
requests it needs to be on top of his game, to have it authorized. Be pro
active in your care, and dont back down. Pictures are a must, to prove to
the ins co what you are living with now. it isnt always easym but its
doable if u can get your physician to change tactics and request the
surgery for several reasons. Make sure u do have pics no matter how
embarassing they are.
Good luck
Cindi -227
— DollyDoodles
June 7, 2006
I don't want to sound negative but..... My insurance would not pay for
anything!!! Not even for my stomach, and yes I had rashes & every
nuisance that goes along with extra skin. I have lost a total of 211-216
pounds (but now I am pregnant and up 9, LOL), I have had pretty much every
area of my body tightened or pulled up or down (and I still need some
work).. I went to the teaching hospital and had a last year
"resident" do the work. I was pretty pleased with most of the
outcomes, but I shouldn't have hoped for perfection because as far as I was
stretched out, there is no way to look like an 18 year old who has never
been Fat (which was my goal), ROFL!!! But even with a resident I paid
about $21,000 (well I am still paying, LOL)!!!! GOOD LUCK, I hope your
insurance comes through for you!!
— GAYLE CARMACK-LYONS
June 7, 2006
YOur lucky the insurance paid for any plastics. Alot of people's insurance
won't pay at all even with rashes etc. Its considered cosmetic not
medically necessary. Insurance company feels you can function just fine
with loose skin.
I also would like to have plastics but insurance wont pay for it.
I may never be able to afford ($40,000+) for the plastics. HOnestly I've
come too far to let the skin define or detour my life. HOnestly are you
less of a person because you have loose skin? ARe you less smart or clever
because of it? If the insurance company has exclusions for plastics, they
won't pay even with the doctor's letters, because it's their money and
their rules. Remember this isn't life saving/emergency surgery which they
could be forced to pay for. WIth the increasing # of people having WLS, the
insurance co doesn't want to pay for every former fat person's plastic
surgery, so they wont. Think about the insurance this way, if this was a
homeowner's policy, everytime you file a claim, they either drop you or
raise your rates and you find you can't get homeowner's insurance
elsewhere. I know myself I'm grateful for insurance because they have paid
far more for my care than I ever have paid in premiums, we all should
realize that health care is a privilidge and not a right in this country,
if you have insurance & lots of $ and can write the checks you have the
ability to have healthcare, if you have no insurance, no one will take care
of you. Maybe you should start saving $ for your plastics. If the
insurance co. has an exclusion, you really have no grounds for an appeal or
fight, if you can afford to hire a lawyer you could afford self pay. I
honestly am not trying to be mean but I wanted you to be aware of other
peoples situations also.
I wish you good luck
— goldroses
June 8, 2006
I'm sorry that your insurance is saying no the surgery. If you haven't
tried that already, start a journal include everything from pictures of the
problem areas, reciepts for medicine perscription and over the counter,
everytime you see your Primary care doc. don't forget to include things
that seem silly like oder, self esteem, intimacy issues etc. You have to
remember, that even though the weight maybe off, the excess skin that you
have is still hard on your heart and can still cause medical problems. I
noticed your profile says you live in California. There is an amazing doc,
who only works on WL patients. His name is Doctor Katzen and his website is
bodybykatzen.com. Just document everything, because the more documentation
that you have the stronger the case you have built in your favor. Look into
the Dr.Katzen, you won't be disappointed. Good Luck!!
— Jenney
June 8, 2006
Document everything, have letters written by PCP, OBGYN, PS, NUT everyone.
Then write one yourself. Then get the # for Consumer affairs/ Grievance
dept at you Insurance company. Submit this data to them you may have some
luck there. Notice I did not mention appealing, but consumer affairs...
Best wishes.
maryLyn
— Kriola
June 8, 2006
Congrats on your huge success in losing the weight! You have to feel so
much better.
some ins companies pay for a panni - if it meets certain citeria. paying
for other plastics is rare, very rare.
I felt trapped and ugly with the excess skin. so I worked hundreds of
extra hours, borrowed from my 401 K and even briefly considered selling my
husbands car. ( which he offered) If I had to I would get a second job,
or whatever it takes. i was grateful (and surprised) that my ins paid for a
panniiculectomy and that helped, but honestly did not feel they should be
obligated to pay for the rest, I paid for the rest, and feel proud of my
accomplishment and succes in doing so. It is worth the work.
HUGS
— **willow**
June 15, 2006
I want to thank EVERYONE for all the replies! I was surprised to see so
many.....you all are so empathetic and that warms my heart to the fullest!
I am going to keep on keepin on!
— tonesangel
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