PLASTIC SURGERY AND INSURANCE.

I was just curious if anyone out there who has gone through TT and other plastic surgeries had a hard time having insurance companies pay for it. Any advice on how to handle this would be helpful. I have Qualchoice. They didnt give me a hard time at all for wls approval, but I am wondering if I should keep track of my skin during my weight loss. Thanks in advance to any suggestions

I am being denied and have written a 6 page appeal. The funny thing was is they said I could have been approved but my employer changed their policy January 1, 2004 to exclude the bypass and all related surgeries. I dug out my book and that is not what it says. That's why I am appealing. I don't know about yours so my advice is to go for it. Yes they may deny. Be prepared to fight.

It really depends on the particular policy you have. I highly suggest you dig out your summary plan description and read through it. Chances are the answers are in there. Some plans cover plastic surgery if it is medically necessary. Some, like mine, exclude it if it is related to WLS! If you plan covers medically necessary plastic surgery, by all means have your doctor document rashes and any infections you might have. In my case, I am going to request "reconstructive surgery" (abdominoplasty) and see what happens. (There were two women who have the same insurance as I who pretty much got the surgeries excluded last year by arguing about payment. One only had about a pound of tissue removed from her abdomen, the other had multiple plastic surgeries and argued that they should be paid. Since there was no exclusion, they were covered. That got changed for 2004 - no plastic surgery after WLS.) Now, I plan to make my case that the problem with my abdominal muscles existed long before WLS, but due to positive lifestyle changes, it's now a problem. If I still get denied, I plan to eventually pay out of pocket.

Good answer susan. I also brought up that issue in my appeal letter plus I brought up my lower back problems were the result of being out of alignment. Choicecare's so called exclusion is so vague that it is open to any intepretation(sp). Now I know I am paranoid but it seems there is a lot of collusion amongst the employers and insurance companies in Cincinnati. An awful lot of employers and companies are bno longer covering this to be coincidental