Plastic Surgery?

[Toodie1974 39]

Hello All,

I have a question, when you have the wls and lose all this weight and have sagging skin. Do your insurance cover the plastic surgery due to you losing the weight from your wls or do you have to pay out of pocket for these procedures? I know a lot of people say it all depends on how your doctor code the procedures. I just want to hear it from you all since I am pretty sure some of you had the same question.

[spelmanite10 42]

Hello All,

I have a question, when you have the wls and lose all this weight and have sagging skin. Do your insurance cover the plastic surgery due to you losing the weight from your wls or do you have to pay out of pocket for these procedures? I know a lot of people say it all depends on how your doctor code the procedures. I just want to hear it from you all since I am pretty sure some of you had the same question.

It depends I have Aetna insurance and they will cover a Tummy Tuck if the skin sags and hangs below the pubic area and you have documented irritated or skin rashes documented by the doctor.

[JCP 619]

I hope mine does but am not optimistic. My doctor said very few do. His nurse had gastric bypass 4 years ago. She had plastic surgery for her breasts, tummy, and rear but not legs, neck, or face. She said hers was 38k, no insurance. But she is glad she did it. There's no possible way I could ever spend that. I've seen ads for face/neck lifts for about 15k.

[Toodie1974 39]

Thanks for the replies.....38K wow that's a lot of money. I can't see myself paying that much out of pocket for plastic surgery either. Do anyone know if BCBS cover plastic surgery after wls?

[MichiganChic 3,262]

I just had plastics - I lower body lift with autologous fat aumentation in the butt, and brachioplasty. Insurance covered the Tummy Tuck portion, and I paid the rest. Funny, because my abdomen was the least of my issues, but I was glad for any assistance.

[mi75 1,239]

it depends on if your particular policy has ANY coverage for plastics. most do not.

the exception with bariatrics is if after your weight loss, you have a significant apron on your lower abdomen, some insurances will cover removal of it due to mobility, infection and hygiene issues. generally, this is usually NOT a Tummy Tuck, but a paniculectomy.

many of the BCBS policies have clauses that if they will provide ANY coverage of this sort, it involves a specific amount of time also- ie you must lose your excess weight AND maintain a weight within certain BMI parameters for 6 months-1 yr before they will cover it...

lots of clauses, loopholes, etc.

[livvsmum 2,369]

Insurance companies have all kinds of different requirements IF they cover it at all. I had just resigned myself to the fact that I would have to save and save and pay out of pocket. But then I ask my PCP about it at an appointment and he was AMAZING and started the process of documenting problems for me so that I have a better chance of getting it approved as a "medical necessity" rather than cosmetic. I have 2 insurance plans (one through my husband's work and one through mine) so I'm really hopeful that one of them will approve with all the medical documentation. My PCP said 8 times of 10 when he documents things as a medical necessity it gets approved. Fingers crossed!