Need Help w/ insurance in Illinois

New to the message board I am, I need to find out if anyone in Il. having United Health Care,MMCP, has received coverage for any TT or any other skin removal surgery. A friend on Medicare recently confided that he is getting it through them. About 1 1/2 years ago I did see a plastic surgeon my G.P referred me to, he sent a letter & pictures to the insurance but it was denied. I'm now wondering if I did indeed proceed correctly, (I do not have rashes, or weeping skin, I now wear a size 8, but am too self concious to wear shorts, or short sleeved shirts in the summer. Does anyone have any suggestions? Thank-you, Jeannie

Jeannie, I do not have many suggestions for you, just wanted to say welcome to the IL board. I did not have any rashes etc and my PS did not think that my belt lipectomy would be covered so I did not even try. I paid out of pocket. Have you checked with your insurance to see what they would determine would be the factors to have a procedure covered? Sometimes an insurance will cover a panni as opposed to a TT with muscle tightening. Now, my husband's panni was covered with his insurance (Aetna, who did not even cover his WLS) because he had lost over 100#. Maybe it would be worth your while to find out what they (ins) considers as medically necessary to have PS covered after WLS.

Hey there. I have United Healthcare EPO through my husband's work. They were great at covering the cost of the gastric bypass, but won't even considering covering the TT or breast reduction surgery. Everything will have to be out of pocket for me. Sorry I don't have better news for you. Dyanna

The requirements for a TT to be medically covered are: There has to be a medical reason, being rashes, sores, which usually were there before there was a WLS. Or if there was a problem associated to chronic back pain. Even with the weight loss carrying the extra 15-? excess weight of skin could cause people to have lower back pain. But it must be something that has been documented during the course of weight loss. I think this is totally ridiculous. And I do not see any reason why a person should not be covered for a TT if they have kept there weight off. If this is really hurting you emotionally then I would talk to your pcp and ask to go to a therapist. Maybe they will consider it to be psychologically necessary for mental health. Insurance is so oblivious to what is cosmetic and what is physically necessary. Good luck. I would try, all they can tell you is no. Barb S.