plastic surgery help!!

hello, i need help on what i need to do to get my insurer, aetna, to help cover my plastic surgery cost. i have lost over 200 pounds in 15 months. im down to 200 pounds with a bmi around 27 and feel now is the time to pursue this. i visited my pcp for a rash i was getting on some of my "skin folds" on my stomach. he then perscribed medicine for me, and then recommended a plastic surgeon, richard burkett, i visited him for my consultation on the first of june and his office lady told me to do some homework, and now here i am, i need help!! the skin rashes, which do get uncontrolable without medicine, are hopefully my ticket to getting it covered, along with the drastic weightloss aswell, but i am skeptical since i didnt lose the weight with any type of surgery, just the old fashioned way. can yall help me out any way?

I'm kind of surprised that your plastic surgeon's office didn't have any answers for you. I would think that they would have some experience with whether it would be covered. My guess is that aetna will cover it. It's not that uncommon for certain types of plastic surgery to be cosidered a necessity after significant weight loss. And I really don't think that it would make a difference as to HOW you lost the weight. Your history of rashes is the ticket. If I were you, I would call other plastic surgeons in the area and ask them what their experience is when it comes to getting insurance companies to pay for plastic surgery after weight loss (don't forget to mention the rashes.) Surely, there are some surgeon's offices who can give you an answer. You don't even have to tell them that you've already selected a different doctor, just pretend like you're thinking about going to them... In the end though, you're probably going to need it authorized by aetna BEFORE you go. They'll deny it ruthlessly if you get it done before calling them for authorization first. Just call the number on your member card and ask them if there is any coverage for removal of excess skin after weight loss...if necessary, tell them you can get your PCP to write a letter of medical necessity. Anyway, I don't have any experience with any of this...so these are just my suggestions. Wait a bit and maybe someone from obesityhelp who has actually had this done will respond. (The 'insurance' forum isn't the most popular one, so it's not read as often. You'll have to be patient.) Congrats on the weight loss!

You want to take pictures of the rashes and go to your doctor say once a month for three or four months to get a history of the problem. One time will probably not do. You have to show this is medically necessary and not cosmetic. You need the pictures of a "medical" problem and documentation by your doctor. Then you should be OK I would think. Read your policy for PS exclusions as well. Jim Randall