Reconstructive Surgery

I have noticed on the RNY Board that several people have had reconstructive surgery, but the kicker is that their Insurance has paid for it...several procedures. They were approved based on medical necessity. Some, to me, have not been the most extreme cases that I have seen.

Has any African Americans that frequent BAF had reconstructive surgery done that their Insurance paid for? And, what was the basis for the approval?

Yep!  I have.  Insurance generally will not pay for anything considered cosmetic - they will, however, pay for what is medically nessary.  What does that mean?

Example - the stomach area.  SO many of us have issue with it - but correction typcially means Tummy Tuck.  Well - a Tummy tuck is NOT covered by most insurance BUT there is a procedure, called a panniculectomy - that IS.  HOWEVER - the panni procedure will NOT do all the things that a Tummy Tuck WILL - in other words - you ain't gonna be super fine - the panni procedure is meant to get you functional - not pretty........

As for requirements for approval - there is a grading system for the severity of the pannis and usually documentation of associated rashes and such needed to TRY to get approval for it.  The approval process works just about like for WLS - and it can be hard to get through........

Other possible procedures for insurance are breast reduction (that's a HARD one to get) and some leg procdures, I think. 

Curious about your statement on those who did get insurance to pay for their 'not been the most extreme cases I have seen' - what qualifies as extreme enough for insurance to cover it?

Thanks for the info. Now I have some hope of getting some procedures done NOT on my dime.

I was looking at some of the pics that were put up by some of the recipients and their stomach and thighs and breasts were "mild" compare to some people who's skin I have seen rejected. Maybe the Insurance Companies are a little more lienient now or maybe it is the particular Insurance Company.


I'm doing research now on reconstructive procedures because I know of at least 2 procedures I need and want that will make that woman pics on RNY now look like Ms. America.

Actually I got a breast reduction covered pretty easily thru insurance.  No denials or waiting at all.

From my understanding, if YOUR insurance pay for your weight loss surgery, and once you lose the weight and if you have a lot of excess skin WITH rashes you need to document any and all rashes and take pictures, in the tummy area and in the pubic area they WILL pay for a panni removal and SOME insurance WILL Pay for a tummy tuck and/or full lower body lift also breast reduction if they cause pain. But NO insurance will pay for arms.

I think it depends a lot on the insurance company...  Some pay, some don't.  My insurance will pay for panni removal if it meets a certain criteria (if it hangs low enough I think).

If the do end up paying for mine, I will try to negotiate with my surgeon to pay the difference so I can get a full tummy tuck or LBL.