Question:
I'm 16 months out and 110lb down. I'm concern about not being approved...
For plastic surgery. Is there anyway or anything I can do to probably cheat my way in to an approval, Just in case I might get a no from insurance. — Marie V. (posted on March 5, 2005)
March 5, 2005
That would be insurance fraud and you are posting this on a public forum.
I understand your being anxious about not being approved, but if the loose
skin is causing you problems and you are being treated for those problems
then there shouldn't be a problem. Your surgeon should be able to appeal
any denial as long as you have proof of your medical conditions such as a
rash under the folds of skin or back problems, things of that nature. I
wish you the very best and hope you get your approval.
— issymudd
March 5, 2005
Cheat your way to approval??? That is one reason why it is so hard for
many to get approval. There are many people out there who try to make
rashes etc. Just be honest and if you don't have rashes and other skin
problems you should consider yourself lucky! If the sugery is medically
necessary than you will more than likely be approved , and if you aren't
approved for plastic surgery just be happy that you were approved for your
weight loss surgery and with the success you have had with your weight
loss. Just think there are alot of people out there who would love to have
weight loss surgery and their insurance won't cover it. You should be
thankful for what you have accomplished so far.
— FreidaL
March 5, 2005
For Shame!
— MissKimberly
March 6, 2005
Coming from someone who has to fight a yeast infection in my bellybutton on
a daily basis, has open sores on my hanging stomach, and gets rubbed
abrasions on both my stomach and legs where they touch whenever I walk a
lot. I am FURIOUS and appauld that you would consider faking a rash. First
off, that is total insurance fraud...second because of the mass of people
finagling there information to get PS some insurance companies have
starting putting in exclusions for abdomniplasty and panniculectomies (mine
being one of them). So before you go looking for a way to fake a rash,
thank GOD that you are not actually suffering like some of us. And if you
are suffering from the excess skin in some other way, use those legitmate
reasons to try and get approval, and don't LIE!!!
— Sarahlicious
March 6, 2005
This website is for support of the morbidly obese. It's not a website to
discuss how to break the law and commit insurance fraud. Shame on you for
asking for help with something that is illegal.
— Shayna T.
March 6, 2005
HI I'D LIKE TO ASK IF YOU ARE ACTUALLY SUFFERING ANY MEDICAL ISSUES DO TO
YOUR EXCESS SKIN OR IF IT INTERFERES WITH YOUR EVERYDAY LIFE, DO YOU
ACTUALLY SUFFER FROM BACK ACHES, RASHES ECT. DOES YOU EXCESS SKIN HAVE AN
ODOR OR MAKE IT DIFFICULT TO KEEP CLEAN... HAVING A RASH IS NOT THE ONLY
MEANS TO QUALIFY FOR MEDICAL NECESSITY FOR RECONSTRUCTIVE SURGERY... SO
FIRST CALM DOWN. SOMETIMES WE THINK WE DON'T MEET MEDICAL NECESSITY WHEN IN
FACT WE REALLY DO. THERE IS NO NEED TO BE CREATIVE HERE... I TRIED TO
EMAIL YOU PRIVATELY, BUT AM UNABLE TO PLEASE EMAIL ME PRIVATELY...
— tracy W.
March 6, 2005
first off, cheating is not just unethical, it is illegal, insurance fraud
is a felony and you could have your thin butt in jail for a long, long
time. Not really worth it huh? now, for the real way to do this. I was
approved with out any rashes, based simply on how far my pannus hung down.
The insurance company had to see photos taken by my PS, not by me, and sent
by directly him. They said they would not accept pictures etc, directly
from me. Probably had too many issues of *fraud* in the past. Now, mind
you, they would pay only the amount for a panniculectomy. I worked
hundreds of extra hours at my job to help play for the difference out of
pocket to have a LBL and Muscles tightened and brachioplasty, and I fully
paying out of pocket for my thigh and breast lift and augmentation. I will
work as many hours as it takes to pay it off, my husband is going to be
selling his old Mustang, and our tax refund is mine. I am also borrowing
from my retirement account. and THAT is how you get plastic surgery. Use
what, if anything, you legally can get from insurance. Sacrifice and work
for the rest. It may take time, but what is worth having is worth working
for.
— **willow**
March 7, 2005
I'm sorry to everyone who seem to get ofended by my posting this question.
I guess I should've put more details to make my point a little more clear.
Even before my RNY I had rashes under the folds of my skin, under my breast
and between my thigns. They keep comming out and got worst as the weight
would come down. I Have severe back pains. I'm 16 years old and many times
I find my grandma asking me to sit in her chair to ease the pain. I spoke
to my PCP and he game me a referal to see a plastic surgeon next week. The
problem is AND THE WAY MY QUESTION SHOULD'VE BEEN IS:
I HAVE HAD VERY BAB RASHES, UNDER MY BREAST, UNDER THE
FOLD FROM MY STOMACH AND BETWEEN MY THIGS. NOW THAT MY APPOIMENT IS IN TWO
WEEKS I DON'T HAVE THE RASH, HAVENT GOT THEM SIMCE AUTOM AND IM SCARE THAT
I WOULD GO TO THIS APPOIMENT NOT GET APPROVE AND THEN AT THE FIRST SIGH OF
WARM WEATHER HAVING THE RASHES AGAIN.
But again I appologies.
And thank you!
I didn't know this would be breaking the law.
— Marie V.
March 7, 2005
If you documented the rashes, etc. all along with photos, doctor's visits,
receipts for medications (anti-fungals, etc) used to treat the problems,
then it would not matter if at a particular point, the rashes had
abated....JR
— John Rushton
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