Insurance - how to get coverage for plastics

2017 is going to be The Year of the Plastics for me.  Or else.  

My insurance is changing at the beginning of the year, so I can't look into things easily now.  But I'll start finding out what my options are on January 2nd.  

In the meantime, I've been googling and reading personal accounts of how people have gotten insurance to cover plastics (or part of plastics).  I've already documented some bellybutton issues with my dermatologist, and I'll continue to do that.  

I've got to wear compression tights for my cardiologist (orthostatic hypertension), but doing so causes my panni to compress as well which leads to odor and, I assume if I wear them long enough, rash.  I'll be talking to my dermatologist about this issue as well.  

Has anyone here had success with securing insurance coverage for things beyond the pannilectomy?  My thighs and arms cause discomfort during exercise - is that something that a case could be made for with plastics?  If you did get coverage for other plastic surgeries, what justifications did you have?  

I have a plan for self-pay, but I figure with the amount of money I pay for insurance, and the amount they're saving on me now due to my healthier lifestyle, I would be a fool to not try to get as much from them for this as possible.  

I'm still VERY early out, but I developed a yeast infection (tongue and skin folds) while in the hospital for bypass. I had never had this before. When I had my 1st post op visit the NP told me they will document every time I visit and I am to take pictures any time the rash re-surfaces. I use anti fungal powder until the rash is gone, but it comes back a week or so later like clock work! She said I may be able to have the abd. apron removed at the 1 year mark.

My suggestion is document with any and all doctors you see, this will only help your case!! Anything you can get insurance to pay for will help you get more done that they won't cover!!  Good luck!

Medical criteria for coverage of medically necessary plastic surgery can vary by insurance company and by employer group, line of business, etc. within the same insurance company.  So, the only way to know for sure is to ask.  If you know which insurance company you will be covered under at the beginning of the year, you can call their member services department now and ask for a copy of the criteria for your particular plan.  You don't need to wait until after your coverage becomes effective.

This is only general information.  As I said, medical necessity coverage criteria can and does vary.  Generally, only medically necessary plastic surgery is covered and insurance companies require that it is in order to address an injury, illness, genetic defect or for the purpose of reconstruction after mastectomy.  Some plans cover it for gender reassignment, as well. What you will likely need is a documented history of rash or lesions caused by your pannis, and documented attempts of failure of more conservative treatments (e.g., powder, salves or other treatments).  It is unlikely that an insurance company would pay for extra skin on the arms and legs that causes difficulty with exercise. 

Good luck!

 

No insurance company covers cosmetic surgery, but some will cover plastic surgery if there is a health issue.

My insurance company covered a LBL and a gynecomasty but would not pay for my thighs or arms after a 300 lb weight loss. I documented with my dermatologist, and had to appeal the initial decline of both surgeries.

Go to the plastics board. There are a few people there that have had similar experiences.

Scott

I know you are looking for beyond panni coverage and I don't have a story for that.  

However, I did want to say that my insurance coverage has it written into policy that they cover panni's for patients that have discomfort with exercise if related to the panni.  (No skin issues required.)  The surgeon just had to state that in her billing.  I didn't try to appeal to get anything additional covered with my LBL.  

Best of luck in the process.  I ended up being hospitalized overnight which was unexpected.  Since the panni was covered, then hospitalization was easily covered as well.

Mine covers a breast lift and stomach skin removal.  It will not cover arms or thighs, but many surgeons will give discounts for multiple procedures.  I also will be spending extra for the tummy tuck versus the panniculectomy, since after 4 abdominal surgeries and 450 pounds of weight loss, I don't think my stomach muscles are too happy, heh.

We started documenting it in anticipation of having it done in 2-3 years (more likely 3).  The bariatrician I see works with a plastic surgeon that has WLS experience.  Every visit he documents the progress.  I also have prescriptions for nystantin powder and other things which, even if I do not use it daily, is in my medical record that I need it due to fungal and bacterial infections.  

He actually said to take pictures and email them to myself.  That helps a lot for more difficult cases.

You can make a case for arms and thighs.  I have seen one case of arm and thigh lifts getting covered, actually.  I would start having the doctor document your discomfort at every visit.  If your mobility and range of movement are restricted tell the doctor and ask they document it on each visit.  You need to build a history that is strong for arms and thighs.  

I know things are different here in Canada. In Ontario, they typically cover panni only. However there are exceptions. I.e. Sometimes a breast lift can be covered if you can demonstrate the excess skin is causing back and shoulder issues. 

The other way to build a case is to show the excess skin is interfering with your ability to do your job. The example the nurse gave was if you work in the trades, or kitchen, or with certain machinery even, excess skin on your arms can become a safety hazard. And they have on occasion covered that as well.

Best wishes to you. I have nothing really to add other than keep us posted on how you make out with it.