Does insurance cover post-op plastic surgery

sjmel13
on 4/20/06 8:17 am - Milner, GA
I had heard that some insurance companies that pay for the surgery will also pay for 2 follow-up procedures. Does anyone have any experience with this or have had it done through their company?
gary viscio
on 4/22/06 5:05 am - Oceanside, NY
RNY on 07/01/03 with
What type of follow up? Plastic? Mosty companies only cover plastic if it is reconstructive and not cosmetic.
jtrandall
on 7/1/06 11:16 am - TX
Plastic surgery is harder to get covered than wls surgery but not impossible. It has to be medically necessary and not cosmetic. Your skin can hang to your knees but if there is not a medical reason, forget it. So what you have to do is: 1. Take pictures of all sores, rashes etc., in the fold of the skin etc., note dates. 2. See you PCP for all sores, rashes etc., and ask them to make sure they make a note in your record that you came in and what for. Later you will have to get the PCP to write a medical necessity letter. 3. Make sure your PCP will support you with the letter. 4. Be prepared for several appeals. 5. NO from the insurance company means you have to try harder and appeal with even more resolution. Until you get a letter say you have exhausted all appeals and you are confinedent you have done everything (state insurance may be able to help but mainly for self paid insurance plans). 6. Don't forget there are several levels of appeals. 7. Take records of all doctors visits, what for, and phone records with insurance company of what you discussed and when and who you talked to. 8. Many people wait 8 months to maybe 12 months for plastic surgery depending on how much you loose and have to go. Maybe 7 months or so out I would suggest talking with a plastic surgeon familiar with Wls insurance. They will probably be the ones to send in the insurance letter similar to what your wls surgeon did. Jim
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