I Hate Waiting!

[livvsmum 2,369]

So I saw the plastic surgeon this week about having a Tummy Tuck & excess under arm skin removed. I have been waiting until 18 months post op, because that's what my insurance requires. I gave him all my medical documentation, and a copy of my insurance rider just to be sure :-). He took some pics, wrote my report & sent it for approval.

I'm SO nervous & I seriously hate waiting! I feel like I did waiting for approval for my sleeve.

They said I should know by next week. And that if they deny I can appeal :-)

Hopefully I can post again next week saying I got approval for both :-)

[momfromjersey22 403]

I wish my insurance company offered that. Good luck, fingers crossed.

[livvsmum 2,369]

Well they may not...lol. I guess we will see. I've met all the "criteria" so I'm hopeful :-)

[kimpossible67 608]

Omg! The picture taking traumatized me for life.

[AlanaRN 419]

Do most insurances cover this? I have no idea if mine does.

[livvsmum 2,369]

So I got my answer! It was submitted on April 8th (a Wednesday) and received a call from my surgeon's office yesterday, April 13th (a Monday) that I was approved for the panniculectomy AND abdominoplasty. So the wait time from submission to approval was only 4 days if you count the day of submission.

The surgeon said usually they just approve the panni (which is just the removal of the excess skin that overhangs the pubis after significant weight loss, but that not many approve the abdominoplasty, which is your typical Tummy Tuck. He will remove the excess skin, but also tighten everything up, fix the sides up a bit, and basically build me a new belly button. It is horizontal, so hip-to-hip, and the recovery is said to be pretty rough.

So the reason I'm only 1/2 approved and 1/2 excited is that my brachioplasty or arm lift was not approved, even though I have the medical documentation of the same issues occurring with the skin on my arms. So, they will send me a denial letter and it will have the appeal process. I will definitely appeal.

My date for my tummy tuck right now is May 8, but I may push it forward to the beginning of June for a variety of reasons including that I might hear back on my appeal by then & I would much rather have both done at the same time.

Sigh. I know I should be thrilled that I was approved for the panni and tummy tuck, but I can't deny that I'm a little bummed about the arm lift.

[livvsmum 2,369]

You just have to contact your insurance company and find out if they have the rider on the policy that allows for reconstructive surgery. Before doing that, though, call your surgeon and get the "codes" for the panniculectomy and the abdominoplasty, because the insurance company will need the codes to tell you if if is covered. If so, ask them for a copy of the specfic rider. This will spell out exactly what is needed for you to be approved. For me it was (1) at least 18 months post op and maintaining a steady weight, (2) medical documentation that you've tried other medical treatments for the problems the excess skin is causing you and they haven't worked, and (3) photos.

Do most insurances cover this? I have no idea if mine does.

[AlanaRN 419]

Ok thanks. I will do that! Good luck with yours!