plastic surgery

After reading Kathi's posts (I have been lurking lately since I have been so busy), I have been thinking about plastics a lot.  I will be waiting awhile anyways until I get to where I will end up being, but I want to prepare with the doc etc ahead of time.  So to qualify for medical necessity you must have lost more than 50 pounds and kept it off for 6 months.  Check.  And have issues making it medically necessary (rashes etc).  I am wondering how long I should go to the doc for this before I see about submitting something?  I am just starting to call about yeast infections there now.  No real rash, so I need to figure something out...emotional? Make a rash ha ha.

My question....anyone think a breast reduction would be covered by insurance if you have rashes or yeast infections under there?  I would really want an augmentation, lift maybe, but thought they might pay for part and I cover the rest.  I could leave the ta tas if I have to, but the stomach really has to go.

I'll be reading the replies anxiously!  I gotta find me some rashes somewhere!!!!!!!!!!
Good luck!!!!!!!!

Check Wal-Mart...
they have EVERYTHING !! 


Sorry.........couldn't resist !! 

I guess i'm being stupid here, but where are the rashes coming from?? and yeast infections?  I've had saggy ta ta's for a long time, but never had that?

yup, skin rubbing on skin.  My issues are skin boils.  And also some of the scars are actually before losing weight and the scars from my skin digging into my jeans (in the belly button area)  Back issues could be another problem.  But in my case, My back problems are now solved because the weight is off, not from the hanging skin.

I figured out how to avoid the "sag."  I just button mine up in my pants, no need for a bra that way......

But seriously, I think the plastics being covered is different for each insurance. You should check with your's to see what they require. Good Luck!

I know with my insurance...TRICARE I can have the panni removed but not a TT, I can have a breast reduction but I'm not sure if they cover augumentation.  I've always had extra skin on my tummy area from big headed baby boys stretching me out so much and a big chest but I've never had rashes or yeast infections in either place.  It will be a while before I think about either of those.  Those areas aren't going to be much of a problem for me...it's going to be my batwings and droopy hips/butt area....I can see it already!!

Here is a post from another WL board.  Looks like some insurances will cover it if called "reduction."  I have the 6 months covered by going to the chiropractor for years.  I wish I had her insurance.  I am going to have to look into this.

I was able to get my breast lift covered but had to call it a breast reduction. I have Priority Health which is a MI based insurance company.

This is the criteria that they have.

Quote:

2. Bilateral reduction mammoplasty is a covered benefit when all of the following are met: a. The patient has symptoms adversely affecting activities of daily living and quality of life due to severe back, neck, and/or shoulder pain or upper extremity paresthesias, that are directly attributable to macromastia, and that have not responded to conservative measures. b. The operating surgeon documents that the estimated amount (in grams) of breast tissue to be removed or removed from each breast must be more than the minimum amount for a given body surface area (BSA) according to the Schnur Sliding scale (see above) c. Patient is 18 years or older, and d. PCP has referred the patient, and Surgeon notifies Priority Health by fax 3. If the patient does not meet criteria for 2. above, Priority Health requires all criteria for Set a. OR Set b. below: Set a. All of the following: a. 18 years or older 1. Evaluation by a physiatrist who has determined that both: i. The pain cannot be solely explained by a musculoskeletal condition (e.g., arthritis, spondylitis, acromioclavicular strain) and ii. Reduction mammoplasty is likely to result in improvement of the chronic pain 2. The patient has a symptom score greater than or equal to 3 based on the following: Severe Moderate/Mild • Digital (finger) paresthesias 3.0 1.5 • Occipital headaches 2.0 1.0 • Cervical lordosis, thoracic kyphosis, or neck pain 2.0 1.0 • Lumbar lordosis or low back pain 2.0 1.0 • Breast pain 1.0 0.5 • Grooves on shoulder from brassiere or shoulder pain 1.0 0.5 • Intertrigo: rash under breasts 1.0 0.5 • Asymmetry of the breast (>30% difference) 1.0 0.5 Set b. All of the following: 1. 18 years or older 2. Persistent pain and related symptoms despite at least a 6 month trial of therapeutic measures including all of the following: i. Supportive devices (e.g., proper bra support/fitting, wide bra straps) ii. Analgesic/NSAIDs iii. One of the following: Chiropractic care/physical therapy/exercises/posturing maneuvers/osteopathic manipulation 3. The patient has a symptom score greater than or equal to 3 based on the following: Severe Moderate/Mild • Digital (finger) paresthesias 3.0 1.5 • Occipital headaches 2.0 1.0 • Cervical lordosis, thoracic kyphosis, or neck pain 2.0 1.0 • Lumbar lordosis or low back pain 2.0 1.0 • Breast pain 1.0 0.5 • Grooves on shoulder from brassiere or shoulder pain 1.0 0.5 • Intertrigo: rash under breasts 1.0 0.5 • Asymmetry of the breast (>30% difference) 1.0 0.5

My surgery was covered under "Set a". I no longer had the breast weight to get it covered under the first criteria but was able to get it covered on medical conditions alone. I had to have documentation from my PCP and a Physiatrist in regards to the medical problems. I had low back pain, neck pain, rashes and occipital headaches. All were in mild form but with 6 months documentation with my PCP and a consult with a Physiatrist I was able to get it covered.

Hi Tanya,

   I actually need 1 year of documentation of maintaining my weight per Harvard Pilgrim. Even though I had called them earlier and was told by a woman that I didn't need this documentation for even 6 months. I should have known when she had to put me on hold to find out. Boo!   I qualify every other way but that.  

That stinks, but at least you know you qualified on every other front.  It must be so exciting.  The more I think of it the more I want done, although that's just me wanting the body I never had.  I am definitely leaning toward more than the panni.  Probably the tummy tuck, but I want the insurance to pay for as much as I can get them too.

I would be soooo excited if I could get my breasts done too (and pay for the rest of it), but I am not too hopeful.  Paying for anything at this point with these babes seems crazy.  But I just want it done.  At least my stomach so I don't feel like I have to wear longer shirts to hide it.