Plastic Surgery Questions

Hello, I am down 125 lbs and thinking about plastic surgery. I am going to try and get insurance approval for it. I need a tt and arm lift (need boobs too, but I will pay for those out of pocket). I don't know what I should do first. Should I contact my primary care or should I go see a surgeon? What kinds of documentation or records should I be prepared with in order to get insurance approval. I desperately need to remove the excess skin and will not be affording the surgery anytime soon. Any advice would be appreciated. Thanks

Heidi, I'm in the process of looking at that myself. The first step I took was contacting my insurance company and asking what they cover and what the requirements are. Some require a referral from a PCP, others don't. Mine doesn't so I just made an appointment with a surgeon myself to discuss the options and what he thought insurance will cover. It looks like I'll be able to get the boobs done because I get sores when I run, but the panni doesn't hang so there is no hope for that. Now I just have to make decisions about what's important and what I can afford. Linn

Thanks so much for the info. I will be calling my insurance today checking on this. Thanks again

I agree with Linn, check with your insurance company. Each is different on what they require and you may find that you just need to see the PS rather than getting a referral from your doctor. Be sure the PS states that the surgery is reconstructive and not PS. In many cases, insurance will cover reconstructive surgery and with the loss of over 100 lbs it can usually be deemed reconstructive from what I have read from others. It doesn't guarantee that they will cover, but it can help. Mary

Subject: Abdominoplasty -- Reconstructive Vs Cosmetic Here is a position paper on Abdominoplasty defining reconstructive versus cosmetic ICD-9 codes. It might be of help to any of you fighting with your insurance company over paying for your tummy tucks. One of the ladies on another support group won her appeal because of this paper. Here is the URL and you will need Adobe Acrobat Reader to view it. You can usually download it free off the internet if you don't have it. Just search for "Free Adobe". plasticsurgery.org/medical_professionals/publications/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=7119 (add http:/www. to the beginning for the link to work)

Heidi, I went through my primary physician because I had medicaid. I am still waiting for my insurance from my new job to take affect. Be forwarned it is not cheap. I need a mid section lift and the cost is 10,000.00. To have the excess skin removed from my legs is $5500.00. I didn't even bother to price my arms or boobs(which if it weren't for Victoria and her secrets would non existant)LOL!!!!! I am hoping the plastic surgeon codes it as reconstructive. I have lost a total of 170 lbs, I don't think that is cosmetic. I also work part time at the local hospital and one of the dr's here said if I had to pay out of pocket to make sure that I looked for a teaching college for a 3-4 year resident. THey are still residence but a "real" dr over see everything they do. Also, if you are having one procedure done see about having two at once and that will save $$ towards the anestesia bill, hospital/outpatient center bill. Just a few tips I figured I would pass along. GOOD LUCK!! Delainya 321/151-155/ at goal(basically)