Plastic Surgery

Hey all..First of all, Thanks to everyone you wrote me and gave me some great advice from my other post. I was wondering, when did anyone go get plastic surgery to remove the extra skin and lipo and boobs done?..How long did everyone wait?...Did insurance pay for it?..How much?..etc....Any information would be greatful. I know its way too early for me since im only 4 months out and down only 70 lbs but im curious cause i already have soo much hanging skin now. Thanks! Hugs and best wishes Lynda xxoo

I was 14 months out and still had about 60 lbs. to lose, but I did then because I had 3 very large hernias that had to be repaired. I didn't want to have to have another surgery, so I did the hernias and the tummy tuck at the same time. I'm very happy with the results. Joanne

Hi, I was reading thru some old posts and see yu live in white plaines area? who did your plastic surgery for you? I am exploring doctors in that area also mt kisco. THANKS DEBBIE

My WLS surgeon is located in Great Neck, which is in Nassau county and he recommended me to plastic surgeon who is also in Great Neck. His name is B. Donald Sklansky. I'll e-mail you his phone number if you want, but he may too far away for you. He did a great job though and I'm very satisfied. Joanne

i looking to schedule mine for the end of march, i'll be three years out then. i will be starting off with a lower body lift. then i need to have my thighs done. unfortunately i have to pay for it myself. if you are looking to have insurance cover any of your procedures start documenting any medical condditions associated with you problem area. the only way insurance will cover ps it has to be medical necessary. good luck with your journey. donna open rny mar 18 2003 282/144/140

Hi Lynda, I had my bypass surgery on July 8, 2004. I just had a tummy tuck and 2 hernias fixed on November 16th. I lost 115 lbs and the hanging skin on my abdomen was driving me crazy. I had rashes and itching from the hanging skin. If you get it, it's a good idea to complain about it to your PCP and if necessary go to a dermatologist. I did that and got everything documented, including letters of medical necessity to have the skin removed. My insurance company paid for half of the surgery and I paid for the other half. I have to update my profile with my new picture, post surgery. Jackie

My insurance (MVP Health Care) will pay for the tummy tuck if you have lost more than 100 lbs and kept it off for 6 months. Don't know if they will pay for anything else. (I've been looking into it, out of curiousity.)

Violet: WOW~ tell me more..... Is this YOUR or ALL MVP's policy(ies)? *I* have NEVER heard of such a thing? IS it in WRITING? (or just something you heard thru the grapevine)IF so WOW...I know most insurance companies EXCLUDE 'Cosmetic/plastic Surgery', but some will approve (And many take 2 or 3 appeals!) to get a panniculectomy (removal of skin only) IF DEEMED MEDICALLY NECESSARY (Back pain, rashes, hernias, hygeine issues). I had MVP, I lost 157# and they wouldn't touch me! *I* personally did not have A lot of hanging skin (I was also 18 mo out with stable wt for almost a year!)...I self paid for a Lower Body Lift & Breast aug (of course I know they wouldn't of paid for the BA!) and PS removed 4-5# of skin (that is from my tummy, hips/thighs and butt) now I have friends who had a TT ONLY and had 15# skin removed! (I guess amount of wt doesn't always tell the story) I was 'lucky w/ my skin, I was fairly young (30 when I had surgery) and never had kids, and my Plastic surgeon commented "YOUR SKIN still has some elasticity, and wasn't DESTROYED like many bariatric patients due to obesity* Maybe gaining/losing 100# 3x saved me? or genetics? Dunno) I also exercised daily, drank 16 cups water most days and did my protein! I think that helps some....I have not heard of an insuance company paying for a Tummy Tuck (Abdominoplasty which is a panniculectomy + muscle tightening, which is cosmetic to get that flat tummy look!) *This is not to say some don't but commonly they may approve the panni (~$1-2K) and people upgrade (self pay) for a TT (~$4-8K) surgeon fees only. IF we get a Panni approved that usually includes hospital/OR/anesthesia fees so upgrading may only cost a few thousand! Plastics after bariatric surgery has changed w/ insurance carriers ALL paying for a panni (oh about 200-2003) to NOT A SINGLE ONE wanting to pay w/o many appeals (2003-4/5) to now mixed 2004/5-> (per my Plastic surgeon)...So what they (at my PS office) tell people is THE DOCTOR will decide based on consult if he will submit ppwk to insurance for approval (guess he is getting good at judging photos, medical necessity, documentation etc)...Of course there are no hard and fast rules (all or nothing) but generalities... Some people (although rarer) get other surgeries paid, Breast Reduction may be 2nd most common one (if you have enough tissue that is to remove and are near an ideal BW)... I guess what ins co are doing now could change at any moment. We can remember they are out to save money, so if you can prove a $5K+ surgery will cost them less than other care (rash cream/doc visits/chiro visits etc) that is how they think, they do not care if that skin bothers you or not.....(Sadly)...I wish you the best, hope u have a superduper MVP plan that stays that way! I know the trend changed when the rise in bariatric surgeries rose also! (so if they started paying it wasnt that bad, now they have double the pts requesting OUCH they feel that in their ever dwindling purse!).... HUGS From: Jamie (always the skeptic esp. w/ ins companies! cause inlife I have to deal withthem personally & professionally YUCK!) ~ ~~~~~~~~~~ Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"

Hi Jamie, this is ALL MVP, not just my policy. I looked it up at work back in September just before having my surgery and it was there in the BIM (benefits interpretation manual). I'll paste it below so you can see the exact wording, ok? I've worked there for a year and a half, so it's possible they weren't covering it before and started to cover it now? I'm not sure, but they definitely do now and I was excited to see that! By the way, I work in the Utilization Management dept there and I go to the appeals hearings every month, so I learned alot about how they work, which sure comes in handy. Vi ========================== MVP BENEFIT INTERPRETATION Benefit Classification: Surgical Care Item: Panniculectomy/Abdominoplasty following Gastric Surgery or Medical Weight Loss for Morbid Obesity CPT 4 procedure code: 15831 ICD 9 procedure code: 86.83 ICD 9-diagnosis code: 729.39, 695.89, 682.2 Evidence Bases for Policy Some proven benefit. This rating indicates that there are reasonably good data to support its use in the cited application(s). Further research is required to clarify clinical indications, contraindications, dosage/duration, comparison with alternative technologies, and/or impact on clinical outcomes. Description: Panniculectomy is the removal of excessive amount of redundant skin in the abdominal area due to massive weight loss. It is generally seen in patients who have previously undergone a gastric surgical procedure for morbid obesity or from an effective non-surgical diet regime. The redundant skin folds may hang to or below the pubic area causing problems with activities of daily living (walking, sitting, standing, dressing). These skin folds may also cause chronic intertrigo, which may give rise to skin infections, (e.g. fungal, dermatitis, folliculitis, subcutaneous abscesses) problems with personal hygiene or low back pain. An abdominoplasty is a surgical procedure, which tightens a lax anterior abdominal wall and removes excess abdominal skin. It may be cosmetic or reconstructive and may or may not be done at the same time of a panniculectomy. Coverage: Pre-authorization is required and coverage is considered when all of the following criteria are met. Criteria: Pre-authorization is required and Panniculectomy should be considered medically necessary when the all of the following criteria are met: Documentation that the gastric surgery was performed a least 6 months or longer prior to the request of the panniculectomy and the weight loss (>100lbs) has been stable for at least 6 months from either gastric surgery or a medical weight loss program. Documentation that there has been a weight loss of at least 100 lbs from a surgical procedure or non-surgical weight loss program. * Panniculus hangs to or below the pubis AND * Documentation indicates that the panniculus has caused panniculitis, lymphedema or chronic dermatitis that has failed to respond to at least 3 months of medical treatment; OR * Documentation indicates that the panniculus impairs lower extremity mobility or activities of daily living. Abdominoplasty may also be requested and pre-authorization is required with documentation indicating all of the following: Structural defects of the abdominal wall (permanent overstretching of the anterior abdominal wall with a large or long abdominal panniculus with or without rectus abdominis diastasis, ventral hernia). Chronic low back pain (due to functional incompetence of the anterior abdominal wall). Exclusions (Medical) Requests not meeting criteria Exclusions (Contractual) Child Health Plus Vermont POS Out of plan Contract Location: Professional care References: Position Papers From the American Society of Plastic and Reconstructive Surgeons: Treatment of Skin Redundancy Following Massive Weight Loss, June 1996 Abdominoplasty, June 1994. American Society of Plastic and Reconstructive Surgeons; ASPS Study Proves Body Contouring One Year After Bariatric Surgery Safe- Significantly Reduces Complications, October 28, 2003. Specialist's review 7/04 Pre-authorization, participating provider required. New Policy __6/04_______ Effective Date __1/1/05_____ MVP Benefit Interpretation Manual Panniculectomy

Lynda: Hi and congrats on your wt loss so far! I appreciate the skin issue being a nuisance even at 4 months! I wore extra tight spandex panty girdle type things for the first 1.5 yrs to hold it in! The recommendation for timing for plastics is USUSALLY at least a year out, Up to 2 yrs. It all depends on the medical necessity (some may not be done losing it all but sever hernias etc require the panni removal be done early). I recommend as most Plastic Surgeons that your wt be stable and as close to ideal as possible for 6 mo. So 18 mo is a time many start the PS consult process. I recommend you see a PS who IS very familiar and skilled inworking with post bariatric patients, (GEt referrals form support groups on who they used!) THIS IS VERY IMPORTANT! Our issues w/ skin etc are different than what most PS deal with (some may look at us and say I do not know where to begin) that shouldnot be! (trust me I know a person who saw a PS who said that to her!) thank goodness she ran far and fast from his office! I posted to Violet (see below in this thread)about what most ins will pay for (PANNI REMOVAL ONLY) No lipo or Tt or boobs (unless a reduction PERHAPS)...MEdical necessity is key (So document any pain/rashes etc through PCP when they happen! DO not treat those yeast infections yourself!)..So keep up on protein, vits, water and exercise to do all u can for u! My PS was self pay. I recommend Dr. Joshua King (*EXCELLENT surgeon and very familiar w/ us Wlsers!) He is in Albany www.albanyplasticsurgeons.com for more info..... I had Lowerbodylift and breast augmentation only at 18 mo out (6/9/04) and recent thigh lipo 11/11/05. I can offer research this before u do it ok! Make the best educated and informed decision for you! (surgeon and operation wise!) Costs (remind you they may differ due towhen u have done (meaning my prices are from 1.5 yrs ago!) and pt differences (how much skin removed is how long under anesthesia etc)!) surgeon fee: LBL $5,000 Augmentation: $3,500 Implants themselves flat fee $1,250 -$400 multisurgery discount -10% cash payment ($810) -$75 consult fee credited ~~~~~~~~~~~~~~~~~~~~~~ $8,465 $2,890 Hospital fee for2 nights stay/ or and preop testing $1,440 anesthesia fee ~~~~~~~~~~~~~~~~~~~~~~ total: $12,795 Thigh Lipo: Surgeon/Anesthesia/Hospital (same day surgery) removed 1# fat from each thigh (inner only)...~$3K total.... I put on a 0% interest/0$ balance transfer Credit card *chase card(the first $12,750) and paid monthly w/o fees, then at 1 yr balance transfered remaining $6+ K to another 0% card *Discover card, will be finished paying this may! W/O interest! It is the way to go if you have the credit line! Some people have savings for this (Start saving while losing as they spend less on food!) and others take out home equity loas etc! IT was well worth the money! Want more info email me ok! Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"