Seriously About To Give Up

A little backstory before I get to the question:  In 2011 I was very sick and almost died from a ruptured chocolate ovarian cyst.  I lost 115 lbs. in 10 days (this was mostly infection and fluid). My incision was from my breastbone to my pelvic bone and I lost all abdominal muscle control.  During rehab I was, for all intents purposes, bed ridden.  I was allowed to get up and go to the bathroom and shower, but not much else.  I started gaining weight back after rehab.  I was left with a pannus that as I have relost the weight keeps getting bigger and heavier.  It now is estimated to weigh over 150 lbs.  All of my doctors (cardiologist, orthopedic, primary care, a hospitalist, and two surgeons) all agree that I must have the pannus removed.  My insurance company (which is through my husbands employer) will not pay for this surgery as they deem it a "vanity procedure".  I have been fighting this for five years.  I get recurrent cellulitis and now have pressure sores from the last inpatient stay.  I am diabetic, have high blood pressure, have a-fib, mitral valve prolapse, depression, anxiety, hip problems, back problems, and my legs will turn cold and black if I sit up too long.  Basically I have no life.  I am tied to my sofa (which is also my bed) unless my husband is here to take care of me.  He is our sole support and has had to miss an inordinate amount of time to care for me.  I really am about to give up. Now my question:  Does anyone here know how to help me? This forum is my last hope. God Bless you all.

First let me say I am so sorry for all you have been through.  Usually if you have medical reasons insurance "will" pay for this procedure.  It sounds like you are going to have to appeal their decision.  Here is a link to an article that was written here on OH helping you with appealing your insurance denial. It addresses weight loss surgery but you can just change the words to address your pannus removal.

http://www.obesityhelp.com/articles/7-tips-insurance-appeals

I have also included a link to other members asking the same question as you.  Hopefully you will find some options and answers there as well.

http://www.obesityhelp.com/search/?q=appeal+letter+for+a+pan niculectomy

Keep us posted on how things go?

Thank you Kathy!  I sure will!

What is the self-pay cost? I would find a way to pay for it myself. You should look for a residency plastic surgery program near you to save money.

Thanks Laura.  Due to the size of the pannus and my health history I am looking at around $200K .  I have to plan on ICU for at least 48 hours post op.  My doctor called the plastic surgery school in our state and was told I have to see the bariatric surgeon first.  That's fine except the insurance won't pay ANYTHING to him (he is out of network) and the consult is $350.00 which I don't have. 

Will your insurance pay for bariatric surgery? It sounds like in addition to your pannus, losing weight may improve your health. I hope you find relief.

Thanks  for the reply.  No, they won't.  They won't even pay for a gym membership.  I can exercise in a pool and there is a hospital based center nearby and they won't even pay a portion of the fee. 

Can you start a Go Fund Me page for the initial visit to your Bariatric Surgeon?  I'm so sorry for your trouble, I'm a Registered Nurse and I hate insurance companies!

First of all, don't give up.  You can never give up.  

Secondly, appeal the insurance.  This is causing huge medical risks for you, and they should be looking at that instead of just thinking that you are wanting to have a skin removal surgery as a vanity thing.

Please, please, use the link they provided you so you can get that appeal letter and start inputting your info into it.  Good luck to you.

Thanks Kandace -- I am doing that now.  Praying it works.