The weight on my mind

[hunneybee81 6]

I had the sleeve done in 2015. At the time I was married, with great insurance. When I started to lose a decent amount of weight, my husband decided he wouldn't support me any longer. He quit his job, we lost insurance, he left me and made our children and I leave our home. I got on my feet, mostly, very quickly. Then I met someone. I had another child. I gained 75 lbs back. It was devastating. But I rose up and lost it all again. In total I have lost 137 pounds. Now comes the worst. Time and Time again I have been denied the surgery to reconstruct my breasts and abdomen. My insurance is ridiculous. The standards for medical necessity have been met but because I cannot take the medications they require any longer, they use it as an excuse to deny me. 2 years on diflucan and other anti fungal medicines have damaged my gut biomes. I appealed. They ommited the information on my medicines purposely. I still suffer from rashes but cannot take the meds. They will only consider the rashes as ground for surgery. Not my mobility issues, not the fact that my pelvis is tilted so far forward from the extra pulling downward that my hips sit on top of the balls sockets and my back is swayed. Still, they will not cover my surgery. It's not their life, not their fight. It's a joke to them.

My heart and mind are broken. I'm tired of fighting and cannot look at myself in the mirror. Can't meet my own eyes. I'm a monster. The damage left is something I can't heal from. I did not need perfection. I need some sense of normalcy and will never have it. I can think of only one thing to ease this and I fight it on a day to day basis. Nothing feels good anymore. Not even people telling me how good I look. Not putting on pretty clothes. I'm tired of fighting when this was supposed to be a success. I worked hard. Very hard. As do most of us. But there is no light at the end of the tunnel. I've never (ever) opened up like this. Feel free to roast me because nothing said will bother me anymore. Not more than the pain I feel from simply catching a glimpse of myself, clothed or not.

[Ed_NW 684]

You should just move on from the whole Insurance issue and seek out financing that is specific to plastic surgery. Start looking at options that are offered on this site like bariatric pal mx. It seems like so many people have had WLS and the plastics done in Mexico that it is just as viable an option as getting it done here in the U.S. at a much lower price. Good luck!

[hunneybee81 6]

I have very limited finances and three children. Flying to Mexico isn't an option. Thank you for your words though.

[MIZ60 1,291]

I agree with you that insurance companies are unreasonable about a lot of things and many do not cover what they consider cosmetic procedures. You might try getting one or more of your doctors on board to help appeal the process and explain your situation. I and three other providers wrote letters to one of our CMAs insurance when they denied her panniculectomy about how the pain from the constant infections affected her work and how the infections put patients at risk and they finally agreed to cover it.

I do not know if you work but even with 3 kids there are ways to make money with work from home options. My SIL lives in MA and she did home based medical billing/coding for about 15 years when her kids were growing up. Start a savings account for the procedures you want and eventually you will get there. You might also go see a few plastic surgeons and see if they would be willing to work with you at a discount or with affordable payments.

[Frustr8 7,886]

And I will pray things will somehow fall into place. Self -loathing is real, it destroys you and many snap from the strain of continuing live that way. Stay as strong as possible for your 3 little ones. There has to be a plastic surgeon who will help! Wouldn't it be wonderful if there was one monitoring this forum, or a brother-in- law of someone? See I am a cock-eyed optimist, I STILL BELIEVE IN MIRACLES! If someone can find her an answer, please let her know!

[oopsydaisy 40]

I haven't had any surgeries due to weight loss YET. But I will. I've had other plastic surgery in the past though and it has been my experience that some doctors are better than others at getting things covered by insurance. Maybe it's tenacity or maybe it's thoroughness or maybe it's just better demonstration or wording- have you tried working with a different surgeon?

I know it's tough when you want something so badly- we work hard to reach those weight loss goals! I hope something changes for you soon.

[GreenTealael 25,336]

On 9/24/2018 at 12:02 PM, hunneybee81 said:

I had the sleeve done in 2015. At the time I was married, with great insurance. When I started to lose a decent amount of weight, my husband decided he wouldn't support me any longer. He quit his job, we lost insurance, he left me and made our children and I leave our home. I got on my feet, mostly, very quickly. Then I met someone. I had another child. I gained 75 lbs back. It was devastating. But I rose up and lost it all again. In total I have lost 137 pounds. Now comes the worst. Time and Time again I have been denied the surgery to reconstruct my breasts and abdomen. My insurance is ridiculous. The standards for medical necessity have been met but because I cannot take the medications they require any longer, they use it as an excuse to deny me. 2 years on diflucan and other anti fungal medicines have damaged my gut biomes. I appealed. They ommited the information on my medicines purposely. I still suffer from rashes but cannot take the meds. They will only consider the rashes as ground for surgery. Not my mobility issues, not the fact that my pelvis is tilted so far forward from the extra pulling downward that my hips sit on top of the balls sockets and my back is swayed. Still, they will not cover my surgery. It's not their life, not their fight. It's a joke to them.

My heart and mind are broken. I'm tired of fighting and cannot look at myself in the mirror. Can't meet my own eyes. I'm a monster. The damage left is something I can't heal from. I did not need perfection. I need some sense of normalcy and will never have it. I can think of only one thing to ease this and I fight it on a day to day basis. Nothing feels good anymore. Not even people telling me how good I look. Not putting on pretty clothes. I'm tired of fighting when this was supposed to be a success. I worked hard. Very hard. As do most of us. But there is no light at the end of the tunnel. I've never (ever) opened up like this. Feel free to roast me because nothing said will bother me anymore. Not more than the pain I feel from simply catching a glimpse of myself, clothed or not.

Why don't you just *take* the meds and not get better do they have to approve the surgery? Am I missing something? Possibly...

The other poster is correct in trying self pay options... Skip the insurance drama if you don't think it's going to workout, I've seen people get part time jobs just for plastic surgery...

Safe Journey!

Edited October 9, 2018 by GreenTealael

[hunneybee81 6]

Yeah, you are missing something. I have already taken the meds. The doctors will no longer prescribe them. Self pay isn't an option. Thanks though

[GreenTealael 25,336]

Well sorry about that 😖

[TheRealMeIsHere! 863]

@hunneybee81 Are you followed by an orthopedist for the mobility issues?

If so, have THAT doc refer you for skin removal, far more effective that the plastic surgeon referring. Possibly a letter from you, as well, stating things like your physical limitations & how exercise & mobility is crucial for maintaining the weight loss & avoiding co-morbidities. If there are any co-morbidities that were resolved by weight loss, mention those, too.

With an ortho referral & my letter, my ins. covered 100% of TT/Panni. Most likely, they will not pay for breasts, arms, etc....