Insurance Coverage?

[BeckyinTexas 3]

I have lost over 260 pounds and quite frankly, I now look like a deflated balloon! When I first started losing weight, I was just so thrilled to be losing, I told everyone that ever mention cosmetic surgery that I didn't ever want it. Well, it's a different story but I don't think my insurance will pay for it and I certainly can't afford it. I have United Health Care. Does anyone know if it would be covered?

[anonemouse 1]

I think it'll depend on your specific policy, just like with banding. From what I understand, though, even if the policy covers it, the insurance company generally won't approve it unless the skin is causing some major, chronic issues (rashes, infections, etc.).

[abeaher 0]

I have heard that a "plastic" surgeon as opposed to a cosmetic surgeon can perform abdominoplasty on the grounds of a hernia repair or risk of a hernia d/t the stretch out abdominal wall. I don;t know if this is for sure, but worth looking into.

[Dr.JLo 1]

If you have documented medical problems from the excess skin, you may be able to get insurance to help.

Hernias can be fixed at the same time, but have no relation to excess skin and the insurance companies go to great lengths to provide the research that shows this on their websites:

Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair

AETNA and most of the other companies adgere to these guidleines.

"Aetna considers panniculectomy experimental and investigational for minimizing the risk of hernia formation or recurrence. There is no adequate evidence that pannus contributes to hernia formation. The primary cause of hernia formation is an abdominal wall defect or weakness, not a pulling effect from a large or redundant pannus."

Because I am double board-certified (in general surgery and lpastic surgery) I will repair the hernia while I do the Tummy Tuck. The hospital will agree to seriously discount the fees they charge my patients for the tummy tuck, and the overnight stays are also covered.

In this manner, a hernia may "help" you receive a tummy tuck at a discounted price.

Realize that a "panniculectomy" is NOT an abdominoplasty and does not provide a result that I consider favorable...so beware of a physician who will do a "panni" and call it a "tummy tuck."

"Panni" photos are at

PictureTrail

John LoMonaco, F.A.C.S.

Plastic Surgery

Houston, Texas

www. Bodylifthouston .com

John LoMonaco M.D., P.A.

[TracyinKS 7]

In my company SPD (plan document for insurance) It has a special section for Obesity related surgery and clearly states that it covers revisions and removing the excess skin related to weight loss. It clearly calls out extra skin on the abodomen, arms and legs...... whethere or not it would cover a tt rather than pani removal is yet to be determined.

I have been told that most ps's don't want to even "mess" with insurance.. but when the time is right I will surely try this route.....

I have BCBS and because my company has this provision.... they covered my band with no problems.

[Dr.JLo 1]

That's a great provision !...I wish we had that down here in Texas, where we rarely get coverage unless there are 6mos of documented medical problems from the excess skin.

We still attempt insurance coverage, and continue to have a lot of delays and claim denials.

Insurance companies settled for around $2 billion for unfair business practices such as these, with BCBS contributing around $128 million. These settlements were for an "alleged scheme to defraud doctors."

Worth reading for those who wonder why some physicians may be reluctant to take insurance these days...

http://www.hmosettlements.com/settlements/bluecross/BCBS-pressrelease.pdf

[TracyinKS 7]

This is what I'm HOPING pays for my PS... it is an actual scanned page of my SPD

[Dr.JLo 1]

Thats great...seems like they are getting away from what THEY deem as "medically necessary."

[phenry 0]

I wonder if these changes in policy could help patients who are seeking bariatric surgery get approvals? There is a huge difference from policy to policy, but it still seems to always involve jumping through so many hoops. Realizing that bariatric surgery is not to be taken lightly I still believe meeting the criteria should be a simpler process.

[IWannaBeSkinny 0]

This is what I'm HOPING pays for my PS... it is an actual scanned page of my SPD

Wiring mouth shut for weight loss? at first I was thinking NO WAY is that true! Then, google to the rescue, it is a form of WLS.

SCARY!

[Sula 0]

Just got my second denial for breast reduction. First it was the 6 months conservative treatment. My regular doc fired off a letter supporting that I've done all that. Then, today, it isn't medically necessary because the PS estimated the amount of grams to be 500 (to be removed) and that doesn't work for Cigna as they require 625 grams. I feel so frustrated and actually tearful.

I have so many things I want to do that are impeded by my large breasts and the pain I get when I do certain activities. I've had shoulder pain for two days this week..and I haven't done anything in particular. Oh, duh, just started my period and so the girls are probably a bit more swollen and therefore, I'm packing around a bit more.

I guess they would prefer if you had the reduction before you lost weight so the grams would be there. And that would make so much sense...NOT. I haven't lost all that much in my breasts.

Who makes these rules? Oh yeah, insurance companies...like it is their money. So they can pay those excs the big bonus' I guess.

[lapbandbarb 0]

Thanks for the info. I am just starting to investigate what my insurance company might require in order for them to cover some skin removal. Anyone have any suggestions on what I can have my GP evaluate me on to get my records rolling?

[Kelbell 0]

I too have United Health Care, I was told, no way no how that they would cover reconstructive surgery. When I asked the representative what if I was experiencing medical problems, again I was reminded no way, no how.

Edited March 29, 2009 by Kelbell

[RUBALCAVA2004 0]

I was just approved by my ins. for breast reduction, and had no problem at all getting the approval. I understand your fustration because I for sure did not want to finance my reduction like I did the band! ( i didnt have ins. then) nor did I want to wait to continue to gain wait while I got ins, or the ins. tells me to diet first.... well if I lost weight with a diet I would not need the band! Keep fighting it and find a good ps that will write an excellent letter to your ins.! Good luck