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02-01-2006, 04:14 PM
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#1 (permalink)
| | WLS Master Guru
Join Date: Feb 2006 Location: Near St. Louis, MO
Posts: 636
Weight Statistics June 17, 2005 Start Date:
June 17, 2005 Surgery Date:
5' 2"
Height:
313 lb Start Weight:
268 lb Current Weight:
220 lb Goal Weight:
45 lb Weight Loss:
48 lb Lb Left to Lose:
14.3769968051 % % Lost:
July 15, 2010 Goal Date:
Body Mass Index57.2421956296 BMI Start:
49.0124869927 BMI Current:
40.2341311134 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|  insurance coverage for plastics
How difficult is it to get insurance coverage for plastics work? I was unable to get my insurance to cover my RNY surgery due to an exclusion and was wondering if I should even try for plastics!
__________________ Shelley He who finds diamonds must grapple in mud and mire because diamonds are not found in polished stones. They are made.  | 
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02-01-2006, 07:37 PM
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#2 (permalink)
| | Administrator
Join Date: Oct 2005
Posts: 469
Height:
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This is nearly impossible. You have to show a TRUE medical necessity. I have personally only known one person who was approved for this. Although is was not a full tummy tuck. He was able to have a panniculectomy. This is just lopping off the skin right at the front waistline. 
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Craig T
13.5 years PostOp
Open RNY - 2 TT's
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04-01-2006, 09:38 AM
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#3 (permalink)
| | Whipper Snapper
Join Date: Nov 2005 Location: McKinney, TX
Posts: 13
Weight Statistics 01/01/2003 Start Date:
05/12/2003 Surgery Date:
5' 5"
Height:
337 lb Start Weight:
220 lb Current Weight:
185 lb Goal Weight:
117 lb Weight Loss:
35 lb Lb Left to Lose:
34.7181008902 % % Lost:
12/30/2009 Goal Date:
Body Mass Index56.0736094675 BMI Start:
36.6059171598 BMI Current:
30.7822485207 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
 | Insurance approval for plastics
I agree w/Criag, this is "nearly" impossible. The only time I've seen it approved is for the person who has significant wound care and infection issues in the area under the pannus (the excess skin). Couple of hints: Check your benefit document to make sure they don't absolutely exclude panniculectomy, abdominoplasty or plastic surgery after weight loss surgery (yes they are getting that specific). Also check the exclusion for cosmetic surgery. It usually says something about the procedure that doesn't improve a physiologic function. If you have a hernia that needs to be repaired, or another type of procedure that you need done, maybe the plastic surgeon could go in at the same time. Then you usually don't have to pay the hospital stay (your insurance usually covers that because of the other covered procedure) and you only have to pay the plastic surgeon out of pocket. Best to work with your plastic surgeon and have him formulate the letter to the insurance company to show them what functional impairments exist (infection, wounds, severe back pain limiting the ability to walk). If none of those exist, it's not likely to be covered, but best to ask and have them say no than to never ask the question and miss out on potential coverage.
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04-01-2006, 06:11 PM
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#4 (permalink)
| | Seasoned Veteran
Join Date: Feb 2006 Location: McGuire Air Force Base, New Jersey, USA
Posts: 2,495
Height:
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I have heard of some people being approved for having rashes under the excess skin. These may just be mysterious urban legends, but worth trying for if it works.
Janae
__________________  "Being happy doesn't mean that everything is perfect...it means that you have learned to see past the imperfections. "
Surgery date April 4th 2006 
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09-19-2006, 07:09 PM
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#5 (permalink)
| | Newbie
Join Date: Sep 2006 Location: Arlington, Texas
Posts: 5
Height:
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Hi, I just had a laperscopic surgery and asked the surgeon if he knew of a way to get insurance companies to do plastic surgery on the excess skin that I have. He said that insurances will cover the tummy area if the excess skin is causing a severe rash. So, it's not an urban legend, according to this surgeon. I am constantly lifting the excess skin cuz it sticks to me and I clean that area good, so that I don't get a rash, maybe I should leave it alone, so that I do? LOL
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09-19-2006, 07:13 PM
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#6 (permalink)
| | Seasoned Veteran
Join Date: Feb 2006 Location: McGuire Air Force Base, New Jersey, USA
Posts: 2,495
Height:
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I would wash still, but when you get close to wanting the surgery go for broke....lol
Janae
__________________ "Being happy doesn't mean that everything is perfect...it means that you have learned to see past the imperfections. "
Surgery date April 4th 2006
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09-19-2006, 08:35 PM
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#7 (permalink)
| | Whipper Snapper
Join Date: Aug 2006 Location: Birmingham, Alabama
Posts: 19
Height:
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It is not really impossible to get preapproved, but it's getting more difficult as insurers are tightening their criteria. Whatsmore, the insurance companies when they do authorize, have established a reimbursement fee (20-30% of an average abdominoplasty fee) that makes insurance-based post-bariatric plastic surgery an unsustainable part of their practice for many surgeons. With the increased operative time, higher complication rate, and much greater degree of pre/postop care you will likely increasingly find it few Plastic Surgeons willing to do this for insurance rates.
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09-19-2006, 08:37 PM
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#8 (permalink)
| | Seasoned Veteran
Join Date: Feb 2006 Location: McGuire Air Force Base, New Jersey, USA
Posts: 2,495
Height:
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What a bummer. Don't worry Dr. Oliver. We won't shoot the messenger. We love ya and you are good to have around.
Janae
__________________ "Being happy doesn't mean that everything is perfect...it means that you have learned to see past the imperfections. "
Surgery date April 4th 2006
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02-04-2007, 01:42 PM
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#9 (permalink)
| | Guru In Training
Join Date: Jan 2007 Location: NewEngland
Posts: 335
Weight Statistics 9/1/2006 Start Date:
5' 1"
Height:
278 lb Start Weight:
188 lb Current Weight:
130 lb Goal Weight:
90 lb Weight Loss:
58 lb Lb Left to Lose:
32.3741007194 % % Lost:
05/2008 Goal Date:
Body Mass Index52.5219027143 BMI Start:
35.5184090298 BMI Current:
24.5606019887 BMI Goal:
Weight Loss MethodPhysician Prescribed Diet/Exercise
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The last time I was a size 6/7, I took a class on body image (I'm a therapist) and was complaining to the instructor that I'd be happy w/my body if I could just get rid of this dangling "thing" (pannus) at the bottom of my belly. Of course she had some cute colloquialism about it being referred to as a "mother's apron". Then she broke my heart by saying it would NEVER leave me no matter how much I exercised, how thin I got, worked on my skin tone, etc. It could only be surgically removed. Ooookay. BUT the freakin thing isn't even firm when I'm at 278 lbs! It still dangles. I never had it until I had 2 c-sections. What actually seems to happen is that the c-section scar is firm and THIS stretched out skin flops over it. It rubs against the skin underneath it. That skin breaks down, bleeds, can't heal--is sometimes affected by yeast, develops odors even THOUGH I'm constantly after it w/babywipes. AND... The insurance that I had at that time turned me down for having the whole mess removed. It wasn't considered a medical necessity or severe enough. I thought it was/is!!! Mya 
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