How many have had insurance cover PS?

[mgrand 81]

I am just wondering how many have been able to get PS and have it covered by their insurance. I've heard that it is more likely to be covered if there are complications, such as infections, etc.

[catwoman7 11,214]

you are correct - insurance companies will sometimes cover it if you have documented proof of medical problems from the excess skin, like chronic rashes. See your PCP when something flares up so you'll have a paper trail. Without a medical necessity, it's not likely to be covered.

[Stella S 612]

My insurance does not cover plastics

[NYJenn 1,463]

Each plan is different, take a look at the specifics for your plan

[zombieskayer 84]

Depends on your plan and if you have issues usually. My doctor told me to tell them EVERY SINGLE TIME I have an issue extra skin related, rash, tears etc. So right now my current issue has been there is a stretch mark that I have on my hip that likes to split open because of my skin. So I have them log it every single time it opens up and if it gets any infections so there's more likely a chance for insurance to cover the surgery. The doctor said if I make the complaints insurance will see it every time.

[Frustr8 7,886]

And take pictures even just on your Smartphone, documentationion goes a LONG WAY toward proving it has an effect on your life, not just a Vanity Surgery!

[RickM 1,747]

Typically, if they cover anything, it will be reconstruction for medical necessity (that is what you have to establish, so document all related problems). They will cover, if at all, the minimum to restore function, so the most that we typically see would be for a panniculectomy (cutting of that overhanging skirt of loose skin) but not an abdominoplasty (tummy tuck) which will usually have some muscle tightening along with more extensive sculpting, or a lower body lift, arm lift, etc. If they cover anything minimal, any additional work is on your ticket. Likewise, hernias - incisional or umbilical - are often a ticket to partical coverage as the hernia can pay for a base charge for the OR , anesthesia, and day or so of hospital recovery, with the additional time and labor for additional work paid by the patient.

[TheRealMeIsHere! 863]

Mine did!

Search your ins. site for 'criteria for panniculectomy' (typically, this is the only procedure ins. will cover)

If you have a doctor that has been following you for problems due to excess skin. Take the list of criteria to them. Have that dr write the referral & necessity of the procedure. Make sure they touch on as many ins. criteria they can.

I went to pain management as I have many physical issues. He wrote a referral, touching on all the points ins. was looking for.

Took that to plastic surgeon, who took pics & wrote her own prior approval request. That was sent, as well as letter from pain management. I also wrote my own letter stating the co-morbidities that were resolved with weight loss, how crucial exercise is to maintenance & keeping those co-morbidities gone, and how the pannis was impacting my limited options for exercise.

I was SHOCKED, when I got a letter that not only was the panniculectomy approved, but also abdominoplasy!!

Keep in mind, insurance companies want to save as much money as possible. Convince them that, in the long run, it is more cost effective to do skin removal than pay for treatment for co-morbidities, infections, etc......

[mgrand 81]

On ‎6‎/‎24‎/‎2019 at 6:05 AM, TheRealMeIsHere! said:

Mine did!

Search your ins. site for 'criteria for panniculectomy' (typically, this is the only procedure ins. will cover)

If you have a doctor that has been following you for problems due to excess skin. Take the list of criteria to them. Have that dr write the referral & necessity of the procedure. Make sure they touch on as many ins. criteria they can.

I went to pain management as I have many physical issues. He wrote a referral, touching on all the points ins. was looking for.

Took that to plastic surgeon, who took pics & wrote her own prior approval request. That was sent, as well as letter from pain management. I also wrote my own letter stating the co-morbidities that were resolved with weight loss, how crucial exercise is to maintenance & keeping those co-morbidities gone, and how the pannis was impacting my limited options for exercise.

I was SHOCKED, when I got a letter that not only was the panniculectomy approved, but also abdominoplasy!!

Keep in mind, insurance companies want to save as much money as possible. Convince them that, in the long run, it is more cost effective to do skin removal than pay for treatment for co-morbidities, infections, etc......

Thank you! You look great!