Question:
Comment: Why the PS Hassle with kaiser?
It is wonderful that Kaiser allows us to have the surgery however, they know the after effects of such a surgery with hanging skin, huge stomach, low breast, etc. It should not have to be proven through rash documentation etc. to qualify for post op surgery. The fact that you have hanging skin, huge stomach, breast etc. should be enough for them to grant corrective surgery. You gain self confidence in yourself from loosing the weight and it is taken away to an extent when you have to view your new hanging body. It is like going from one extreme to another, a tease so to speak. A smaller hanging body. How great is that. They need to change their policy. People who successfully lose the weight should be allowed to have the corrective surgery with no hassles! Thank You. — sujoe (posted on June 16, 2005)
June 15, 2005
it would be the same justification that led to the laws mandateing ps for
mastectomy patients. its the right thing to do.
— walter A.
June 16, 2005
The reality of course is that these are large companies who are in business
to make money. Weight loss surgery saves them future bills because the
heart problems, diabetes issues, back problems, and joint problems that are
expensive to treat are all cured by weight loss. Excess skin does not
cause patients such serious future problems (nor does it cost them much to
treat). Most plans state that "surgery to correct deformity resulting
from disease" (i.e. breast cncer) is classified as
"reconstructive" not "cosmetic." Why then are patients
treated for morbid obesity not offered reconstrution? I point this
contradiction out whenever they deny plastic surgery. Weight loss
patients, in my experience, clearly do not want "beauty surgery,"
they just want to look more normal. Sorry for the soap box...but it IS the
right thing to do.
— DrL
June 16, 2005
I totally agree. Although admittedly, I may be a little biased since I just
got my denial letter yesterday for my panniculectomy. The reason they
listed wsa that I am not yet 18 months out. Well, since my insurance plan
will be terminated on August 2nd, it's not difficult to figure out why they
decided that. If I wait until I am 18 months out, I will no longer be a
covered employee and they won't have to pay for it. Of course it doesn't
matter to them that I have lost 160 pounds in just over 6 months and have
been at this weight for about 6 months. I would still like to lose another
15 to 20 pounds but I cannot increase the intensity of my workout because
of the hanging skin. It's not like I want this surgery to look perfect. I
know I will never be asked to do a spread for playboy. I just want to be
normal. I can't be anything close to normal with this. There are times when
I think I was much more comfortable with all of my fat than I am now with
this hanging skin. I feel like so much more of a freak. And I believe the
insurance companies should pay for reconstructive surgeries so that we can
feel at least somewhat normal.
— Donna F.
June 17, 2005
Don't get me wrong me when you read this post. I'm not saying you don't
deserve or shouldn't have corrective surgery... If I ruled the world,
weight loss surgery and loose skin removal would go hand in hand and be
100% free to everyone who needed it. It's no fun to battle with the
insurance company and even less fun to get a denial...
I'm just trying to play devil's advocate and put some other ideas out
there.
It sucks to have to go through all the hassle to have loose skin removed...
but there just isn't unlimited money to pass around. And I think it should
go to people who need it for medical reasons before it goes to people who
need it for non-medical reasons (and low self-esteem is not a life
threatening condition).
Life has lots of gray areas and it would be great if everyone who wanted a
non-medically necesary but life normalizing surgery could have one.
This is an extreme over-simplification but has the following occurred to
you:
Insurance companies have limited funds with which to treat patients...
which is better?... weight loss surgery for two people *or* weight loss
surgery plus reconstructive surgery for one patient (who is having no
problems with hanging skin other than the appearance)?
The goal of weight loss surgery is not to improve self-esteem (although it
is a nice plus).
Low self-esteem is not life threatening (qualifier: yes low self-esteem can
lead to depression which can lead to suicide but in that case I think the
money would be better spent in therapy than in the operating room).
One person commented that: "Weight loss patients, in my experience,
clearly do not want "beauty surgery," they just want to look more
normal."
The same argument can be used for women with small breasts, for example,
who only want to look more normal. I'm not talking about going from a C
cup to a DDDD cup.. I'm talking about sub-A cup to A or B cup. That person
wants to look more normal too...
Also, what about people with large noses/hooked noses/ridged noses...
their goal isn't to look like the latest fashion model... it is to look
more normal.
An adult with deep pock marks resulting from severe acne in adolesence who
wants a face peel or resurfacing... he or she just wants to look more
normal too.
The point is many people want to look "more normal"... if
insurance companies start allowing non-medically necesary procedures, they
won't have money for the medically necesary ones and that would be really
unfortunate.
If you've gotten this far and are pissed off at me, please go back and read
my first paragraph. If I ruled the world, medically necesary would be
defined differently and weight loss surgery would automatically come with
excess skin removal and be 100% free... but unfortunately noone has
elected and/or appointed me yet (or given me a key to the national
treasury).
As much as we want to demonize insurance companies for not paying for these
surgeries, they do have reasons. And yes, you can argue that insurance
companies are making profits off of us but that's part of life... I haven't
met any practicing doctors who live in homeless shelters or who are on
public assistance because they can't make ends meet. Maybe in addition to
the insurance companies, we ought to get upset at the weight loss surgeons
and plastic surgeons who charge so much money!!!
Thanks,
Sid
— mrsidknee
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