Plastics Insurance experience?

Hello!  I am curious if anyone has any experience getting approved for body contouring through insurance. I paid cash for my surgery back in 2007 and the amount of excess skin I have is ridiculous and uncomfortable to say the least.  Granted..I do not have boils bursting out of every fold ..I do have issues that i am now realizing that maybe I should start documenting.  If anyone is willing to share can you tell me what your insurance providers requirements were, what type of insurance, your pre op BMI and anything else you think that might be helpful. My case is going to be weird because I paid cash originally in the first place. Any advice would be greatly appreciated. 

Thanks!

If you call it plastic - no insurance will coner it.  Documenting is good.  

Also even if you self pay it - but have documentation that it was medically nessesary - you may be able to deduct it on taxes as elective med surgery. Documentation is good. 

My insurance for not cover RNY and it did not cover any skin removal surgery as a result of weight loss (regardless how I lost it).   But during that year my medical expenses were over 20k and I was able to deduct a large portion of that from my taxes.  (I had proff it was medically required - skin rashes, yeast, pictures, etc) . 

HI! Thanks for responding. But yes... I agree that using the phrase "plastics" with an insurance company may not be the best way to get approved. But I was just curious to see if anyone wanted to share their experiences who had been recently approved. But I forgot about deductions. Thanks so much for that reminder!

I had a "panni" paid for by my insurance because I was able to prove "medical necessity".  Visit your PCP, document rashes, keep receipts for creams, prescriptions, etc.  Even over the counter products can serve as proof.  My WLS did my "panni".  I went to his office and a staff member took a picture of my rash when it was at its worst. 

Again, it's all about good documentation and medical necessity.  I'm pretty sure that's standard across all insurances.

Insurance requirements can be weird.. Aetna actually requires that the skin hang down to a certain amount AND documented support of rashes/skin irritation that hasn't resolved with medical treatment. Even then it's iffy. But I don't think they care how the weight was lost, least my coverage/policy doesn't mention it. And that's just the panniculectomy.

I had Aetna, too, and they didn't even ask about weight loss... Just how far the panni hung down and proof that we tried other ways to get rid of the skin issues.

They were easy deal with in terms of my RNY and panniculectomy approval, but I went round and round with them on them denying the mons lift to go along with the panniculectomy.  They wouldn't budge.

You are very unlikely to get insurance to pay for more than just a panniculectomy (although occasionally people get a full tummy tuck, especially if they have other issues like a hernia)... But body contouring?  If you mean a full lower body lift, that isn't going to happen, I'm afraid. Even with a panniculectomy, many people opt to pay out of pocket to also have the skin above the waist removed if there is a lot of it.  

Really, skin issues and the amount of overlap is what the insurance is most interested in for panni removal.  Some people complain of back pain, but if it is truly just skin you have (and not a lot of excess fat still attached), the skin weighs very little and is unlikely to cause back pain. Some insurance companies specifically indicate that back pain will NOT be considered when determining medical necessity.

The most important thing you can do is find out what your insurance company requires in order to determine medical necessity.  Then you will know what you need to document.

My insurance paid for the panniculectomy, but my panni hung down onto the top of my thighs (I started at a BMI of almost 57) and the rashes were terrible, so that was a simple matter. They would not pay for the mons lift to go along with it, though, and the surgeon would not combine a covered surgery with a self-pay one, so I paid a different surgeon to do that 6 weeks later when I had my arms (also self pay) done.  Later, I paid for a tummy tuck to get rid of the "muffin top" effect of so much skin above my waist.

i tried to get them to cover my arm lift because my bat wings were huge and I was not only having rashes in the armpits, but it was hard to shave that crepe-like skin and if I nicked the skin, I would get infections.  Even after an appeal that included photos of an infected shaving nick and the rash, Aetna said no.

Lora

I don't know what insurance you have but I have heard that Medicare will pay if it is medically necessary meaning rashes, boils, and yeast. The best thing to do is call your insurance and find out what you need to have so they will pay for it. Good luck to you.