arm lift....insurance

findingme · May 15, 2008

I just found my insurance will pay for this IF I can prove I need it medically. Has anyone ever had this paid for and how did you prove you needed it? They are paying for my tummy but I do get rashes. The skin for the arm lift is a huge amount but I dont get rashes....HELP ME....I really dont have the 4500 it will cost out of pocket if they wont pay...

Looking for suggestions

Dr. Schulman · May 15, 2008

While Insurance will pay for a procedure if it is "medically necessary", it is almost impossible to demonstrate necessity in regards to arms.

Those of you who have seen me speak at support groups may have heard this story before....It is the only example that I have heard of where insurance has deemed an armlift as "medically necessary." It is not a patient of mine, and I believe it was in the state of NY:

A woman worked in a kitchen and sustained a burn to her upper arm because the excess skin touched a hot pot while cooking. She appealed to her insurance company claiming that it interfered with her work and was a danger to her. Only after 3 visits to an emergency department for treatments of these burns, did her insurance company agree that it was medically necessary.

This should demonstrate how difficult it is to have arms covered by insurance. If anyone has any success stories, I would be interested in hearing them.

findingme · May 16, 2008

Thanks for your reply. My Dr told me the same thing yesterday that it is basically impossible. HMMMMM........I guess I will be financing it. It just seemed so easy to get my tummy paid for I thought maybe there might be a chance.

I would love to ask your opinion......when you do your surgerys can you do your Tummy Tuck and arm lift at the same time?

Dr. Schulman · May 16, 2008

I commonly perform combined procedures. An arm lift can be done at the same time as a TT. It will make the recovery more difficult because your arm activity will be limited which may make it more difficult to take care of your abdomen.

Combined procedures can be done in motivated patients by experienced surgeons. It should help lower your out-of-pocket expenses because most surgeons will give a reduction in price when procedures are combined. You will also save money on the anesthesia cost because as a surgery gets longer, the hourly rate for the OR goes down. For example, the cost of one 6 hour surgery will be less than the cost of two 3 hour surgeries.