HAS ANYONE GOT INSURANCE TO PAY FOR PLASTICS?

Diana, How does one go about getting their OLD insurance to cover prior denied claims  or does ones new ins now have to pay for the denied claims ?

I can't talk about what is happening in my case.

If I were you, I would submit a complaint to the DMHC, since you are no longer covered by the insurance company that you had when you requested and were denied (presumably improperly) insurance coverage for your surgeries.  I don't know, however, if the DMHC can require your former company to reimburse you for the improperly denied surgeries.

You might want to talk to a lawyer about this - I have heard good things about gmlawyers.com, who are in LA.  Ask for Ms. Colbert.  But this presumes you already had and self-paid for surgery.

On the other hand, if you never had the surgery because you were denied, you could ALSO request reconstructive surgery to be covered by your current insurance company, and see how that turns out - and you could tell them that you think you were improperly denied by your prior insurance and let the current one go after them for reimbursement, since they would be paying for something that should have been covered by the former one before you became insured by the current one.

Got it Thanks

Thank you Diana,
I was wondering how would I find out about the Oregon law???
I wonder if its the same as Cali, would you know how I could find out about that? My insurance dont cover weight loss surgery, but I wonder if it would cover recontructive surgery? I have Provadence I think thats the way you spell it,lol!

I don't believe Oregon has a similar law.  They just put in corrective language in their statutes requiring coverage of reconstructive surgery for breast reconstruction and cleft palate.
http://insurance.oregon.gov/legislature/2011_legislature/201 1-ins_legislation-other_house.html

I don't have time to look for it, but perhaps you can find the actual regulations here: http://law.onecle.com/oregon/743-health-and-life-insurance/i ndex.html

I had my first consultation July 18th and now I am waiting to see if my insurance will approve it.  Doctor told me most insurance companies only pay for a panni and sometimes that is even hard to get.  I had alot of documentations from my family doctor about all my skin rashes I have had because of the extra skin and all the treatments that I tried.  You can go to the plastic surgery forum here and there are alot of great people there that have so much information.  Alot of them went to mexico to get all the procedures done, it's alot cheaper then here and they had great results.  Just remember to keep documenting everything and see your doctor for the rashes if you get any.  It's actually a yeast infection.  Good Luck!

Hello fellow sojourner... My insurance was Health Net and my RNY was paid for except a small co-pay like $100. I had it at Stanford Hospital.
My tummy tuck was 100% paid for. I reported and had my physician document a series of rashes under my "apron" (the fat that hung down). I paid for my breast lift myself. But I had the two procedures at the same time so anesthesia, the hospital stay, and most of the OR time was paid for by my insurance.  I knew my surgeon  as I had previously worked in the same small private hospital in San Francisco.  He remembered me when I had my first visit. He also did not charge me his usual price as  he believed so strongly in what I was doing. Since then I have recommended him to three other women for various plastic surgeries.
I think your insurance can be convinced to pay for the tummy tuck. Just make sure you tell your primary doctor that you had several rashes that you treated with over-the -counter ointments. The breast lift was because I went from a 42DDD to a 36 long! Did not need my arms to be done.
Ask firmly but gently. If you are nice the doctor will bend over backwards to help. Oh. I think I brought the doctor's office a nice box of See's candy.  It always helps!

My insurance did pay for my WLS, and does cover some plastics. I had a full TT Monday which was covered, and I personally know someone who had their lbl and breast lift covered. The only thing I have never heard to be covered was breast augmentation. After massive weight loss it is more reconstructive than cosmetic surgery, and you should definitely work with your dr to get the procedures covered if you can!

I have checked my current insurance policy, and it will cover a paniculectomy (removal of the panni/apron) only if it hangs "below the pubis" (which mine totally does) AND you have documented medical issues caused by the skin (such as persistent rashes, recurring fungal infections, etc.). You typically have to prove medical necessity for insurance to cover it, but this can be done a number of ways (not just rashes, but also things like back pain). Check your specific policy for details.

I am on PeachState/Medicaid in GA which covered my rny and plastics on the first submission.  I had a breast reduction & full tt on Tuesday 7-26-11.  I was also approved for the arm lift which my surgeon stated he will submit for re-approval once I've healed after at least 6 weeks.  I wish you all the luck.