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11-13-2009, 06:23 AM
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#1 (permalink)
| | Whipper Snapper
Join Date: Sep 2009 Location: Chelsea, MA
Posts: 24
Weight Statistics 9/09 Start Date:
12/28/09 Surgery Date:
5' 2"
Height:
239 lb Start Weight:
188 lb Current Weight:
130 lb Goal Weight:
51 lb Weight Loss:
58 lb Lb Left to Lose:
21.3389121339 % % Lost:
12/28/09 Goal Date:
Body Mass Index43.7088969823 BMI Start:
34.3818938606 BMI Current:
23.7747138398 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|  Does any insurance companies allow PS.
I was just wondering if there are any insurance companies that do allow PS after WLS, and if so which ones?
Thank you
Cindy
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11-13-2009, 01:29 PM
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#2 (permalink)
| | Seasoned Veteran
Join Date: Mar 2007 Location: Floyd County Virginia
Posts: 9,445
Weight Statistics September 19th 2007 Start Date:
September 19th 2007 June 18,2012 Surgery Date:
5' 10"
Height:
363 lb Start Weight:
226 lb Current Weight:
170 lb Goal Weight:
137 lb Weight Loss:
56 lb Lb Left to Lose:
37.741046832 % % Lost:
When I get there again Goal Date:
Body Mass Index52.0793877551 BMI Start:
32.4240816327 BMI Current:
24.3897959184 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Well some do some dont. Just because you have Aetna or BCBS etc....... dont mean all the plans will cover what the other one does. The best I can tell you to do is call and ask for the specific type your wanting and see what the guidelines are. I know with the stomach part they have to document every time you get a rash etc....... and be contacted by the surgeons that want to take it off and tell them why. Im not talking a tummy tuck im talking a pannuletomy. That means just taking the skin off and doing nothing with the muscles. SOme have a breast reduction paid for if....it causes back pain as a result of the sugery. Not many get that approved but in cases of severe back pain they will. Due to over large breast nothing else.
Its gonna be hard to get one to pay for it. i have only acutally seen one that paid for a panni and a breast reduction both because she had medical docmentation before hand that they were to large and had alot of skin break down after on the tummy because of the skin rubbing together.
SO call your insurance company and go from there. it all depends on the type of policy not the particular insurance company you have. Like BSBS or Aetna they have thousands of different poilcys out there. All are worded differet.
__________________ Remember Tough times never last Tough people do... This Ribbon is for our Lady Lisa and all the women that fight this ugly disease. RIP Jerry my friend
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11-13-2009, 02:02 PM
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#3 (permalink)
| | Seasoned Veteran
Join Date: Jul 2009 Location: North
Posts: 2,180
Weight Statistics August 20, 2009 Surgery Date:
5' "
Height:
210 lb Start Weight:
102 lb Current Weight:
110 lb Goal Weight:
108 lb Weight Loss:
-8 lb Lb Left to Lose:
51.4285714286 % % Lost:
August 2010 Goal Date:
Body Mass Index41.0083333333 BMI Start:
19.9183333333 BMI Current:
21.4805555556 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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My primary does. I've got BCBS MESSA. I just have to have physician documentation that the PS is medically necessary.
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01-22-2010, 10:38 AM
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#4 (permalink)
| | Big Loser
Join Date: Nov 2008 Location: SW Pennsylvania
Posts: 146
Weight Statistics January 10, 2009 (pre-op) Start Date:
July 24, 2009 Surgery Date:
5' 6"
Height:
276 lb Start Weight:
161 lb Current Weight:
160 lb Goal Weight:
115 lb Weight Loss:
1 lb Lb Left to Lose:
41.6666666667 % % Lost:
Dec 31, 2010 Goal Date:
Body Mass Index44.5426997245 BMI Start:
25.983241506 BMI Current:
25.8218549128 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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I actually just called to inquire about this - I have UPMC and they wanted the medical billing code for the procedure -- so I called the plastics practice associated with my WL surgeon and they gave me the correct code -- you want to say it's a peniculectomy (sp) and not a "tummy tuck" -- all I need is for the surgeon to put the request in -- get the prior authorization from the insurance and Viola --- covered. I won't be having the procedure until I have another baby -- nice to know it's covered, though. Good Luck.
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05-14-2010, 01:47 AM
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#5 (permalink)
| | Whipper Snapper
Join Date: Jul 2009 Location: Anchorage
Posts: 15
Weight Statistics 1/1/09 Start Date:
1/27/09 Surgery Date:
5' 4"
Height:
330 lb Start Weight:
139 lb Current Weight:
140 lb Goal Weight:
191 lb Weight Loss:
-1 lb Lb Left to Lose:
57.8787878788 % % Lost:
5/11/10 Goal Date:
Body Mass Index56.6381835938 BMI Start:
23.8566894531 BMI Current:
24.0283203125 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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I made sure I had every rash documented and got scripts. A ps told me it had to be followed for at least three
onths. I called the insurance company and they said my primary physican had to make referral. He put it in and now ps doc has to make a case for surgery. I have appt in two weeks. I'll post an update and let you know.
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01-06-2011, 02:05 AM
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#6 (permalink)
| | WLS Mentor
Join Date: Jan 2011 Location: Jackson, Mississippi
Posts: 1,150
Weight Statistics dec. 2010 nutrisystem , surgery process august 2010 Start Date:
April 4, 2011 Surgery Date:
5' 6"
Height:
310 lb Start Weight:
215 lb Current Weight:
180 lb Goal Weight:
95 lb Weight Loss:
35 lb Lb Left to Lose:
30.6451612903 % % Lost:
APRIL 2012 Goal Date:
Body Mass Index50.0298438935 BMI Start:
34.698117539 BMI Current:
29.0495867769 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
| Barbara Sutton
This is good information for me. I have not had surgery yet, still in phase two but am having skin break down issues where my stomach is hanging. Thanks for the info. Will make sure this is documentated.
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01-06-2011, 06:47 AM
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#7 (permalink)
| | Seasoned Veteran
Join Date: Apr 2007 Location: Central Virginia
Posts: 2,952
Weight Statistics 4/30/2007 Start Date:
9/5/07 Surgery Date:
5' 4"
Height:
233 lb Start Weight:
127 lb Current Weight:
125 lb Goal Weight:
106 lb Weight Loss:
2 lb Lb Left to Lose:
45.4935622318 % % Lost:
Body Mass Index39.9899902344 BMI Start:
21.7971191406 BMI Current:
21.4538574219 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Just be aware that a panni is not the same as a tummy tuck. The insurance companies will pay for a panni if you can show that it's hanging down enough to obstruct your ability to walk, or if you have recurring rashes (in other words, go back to the doctor every time you have another break out, one visit won't do it).
The panni only removes the part that hangs below your pubis, so if your belly button is down below your privates, then you won't have a belly button after the surgery. Plus there's no contouring, shaping so it will look kind of strange. The good news is, most PS will make a deal with you to go the extra steps for a true tummy tuck and you only have to pay the difference.
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Highest 233, Lowest 122, Current 127
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01-08-2011, 01:32 AM
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#8 (permalink)
| | Newbie
Join Date: May 2010
Posts: 6
Weight Statistics July 2005 Start Date:
July 2005 Surgery Date:
5' 10"
Height:
400 lb Start Weight:
239 lb Current Weight:
195 lb Goal Weight:
161 lb Weight Loss:
44 lb Lb Left to Lose:
40.25 % % Lost:
12/2011 Goal Date:
Body Mass Index57.387755102 BMI Start:
34.2891836735 BMI Current:
27.9765306122 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Quote:
Originally Posted by Colleywobbles30  I actually just called to inquire about this - I have UPMC and they wanted the medical billing code for the procedure -- so I called the plastics practice associated with my WL surgeon and they gave me the correct code -- you want to say it's a peniculectomy (sp) and not a "tummy tuck" -- all I need is for the surgeon to put the request in -- get the prior authorization from the insurance and Viola --- covered. I won't be having the procedure until I have another baby -- nice to know it's covered, though. Good Luck. | peniculectomy is totally different then a tummy tuck though...your muscles will not be tightened. Also going all the way around if necessary if tons of weight loss. I had my lower tummy done an should of had the whole anchor T tummy done b/c now I have to lose my 40 pounds an then go in an get cut from breast to pubic
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01-08-2011, 02:30 AM
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#9 (permalink)
| | WLS Mentor
Join Date: Jan 2011 Location: Jackson, Mississippi
Posts: 1,150
Weight Statistics dec. 2010 nutrisystem , surgery process august 2010 Start Date:
April 4, 2011 Surgery Date:
5' 6"
Height:
310 lb Start Weight:
215 lb Current Weight:
180 lb Goal Weight:
95 lb Weight Loss:
35 lb Lb Left to Lose:
30.6451612903 % % Lost:
APRIL 2012 Goal Date:
Body Mass Index50.0298438935 BMI Start:
34.698117539 BMI Current:
29.0495867769 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
| Barbara Sutton
Wow, thanks, I can hardly wait. All the information I am getting from this site is awesome. Thanks again.
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