Thanks to all *****sponded -

Mark, Here’s what I know…. My panniculectomy was completely covered by my insurance. And, a Tummy Tuck was also ‘approved’ but I didn’t go for it, But rather had the less invasive procedure. Why was my PS covered? Well, I think for a few different reasons. I had experienced some rash problems and had them dealt with by my PCP Over the course of a year. She had sent me on to a dermatologist. The "rash" or rather chaffing wouldn’t have been quite such a concern, Except, I’m on Coumadin for my Artificial Heart valve. My blood doesn’t clot, by design, and therefore, The slightest rash, can be a few days of bloody underwear waist band If not instantly addressed. Follow? So, my PCP recommended Plastic Surgery to remove excess skin. I had a history of Complications resulting from surgery So I was very reluctant to have it done. That led my Doc to pass me on to a dermatologist for some Better ointment, I assume. Two trips over the next 5 months to the dermatologist, For the same problem that flared up when I added running to my exercise, And he likewise recommended Plastic Surgery. My Bariatric Doc recommended it, my PCP, and my Dermatologist. Only then, when it was obvious that this would be a life-long problem If I didn’t have PS, did I seek a Plastic Surgeon. I interviewed a number of them. Two actually went the whole way to seek insurance approval. Both were approved. One for a panniculectomy, the other for a full abdominoplasty. I went with the doc that did the less work but achieved the medical results I needed. About the photos? Those are submitted to the insurance company by the doc’s office, Not from the individual. Even if there were available photos from An alternative source, I think you would be hard pressed to find a PS doc, willing to join in such a scheme. As for "medical necessity," a stomach or pannus removal may be the easiest To justify, but arms, thighs, chest, neck, etc…would be really, really rare. Some areas that are "red-flags" to insurance companies are- Claims that excess skin is causing emotional or psychological distress… They will deny it outright, many specifically list such as a reason for denial. Also, excess skin contributing to "Back problems/pain," is another instant "flag on the play" for insurers. There is some study (sorry, can’t find it on my hard drive) that concludes No correlation between removal of excess skin with improvement of Back-Pain. They use that to flatly deny any claim that even includes Back issues along with Dermatological problems. Your quickest route may in fact be cleaning up credit. Maybe checkout-

FINANCING FOR WLS &/or PLASTIC SURGERY http://www.SurgeryLoans.com http://www.MyMedicalFinancing.com http://www.MediCredit.com http://www.P-F-S.com http://www.CogentFinancialGroup.com http://www.thfusa.com/?d=041805CA http://www.CiterraFinancial.com http://www.CareCredit.com http://www.CapitalOneHealthCareFinance.com

That’s all I know…. Hey, Hope you win the lottery. Best Wishes- Dx

Hey Mark... before you "bend a rule"...make sure thee are no other options...if you need all that....you probabely have a shot at it legit... get you camera, and start snapping and cataloging...I had the thighs don't yesterday...all this PS is very uncomfortable....find what the insurance company wants....then work at getting it to them...go to the doc every month for documentation....get the scripts filled, and use the same pharmacy, or keep a record of all the scripts, and eveny week, snap the nudy pics... Just like WLS...give em what they want..and they can't turn you down.. Russ

Greetings, Mark. In case you didn't fully read the first replies to your situation, go back up and read them then read them again. 1st - If you want it bad enough, work for it.  I spent almost three years fighting with insurance companies just to get my WLS.  End the end, it was worth every minute of every struggle.  Even though I considered some vicious things that would have landed me either in prison or hell, I just stayed the course and never gave up.  Don't do anything that would jeopardize your character or integrity.  You don't want to be celled up with some 7 foot tall 500 pound monster who has seen any.........well, you get the idea. 2nd - Consider your other options and always be working on a contingency plan right up to the moment that they knock you out for the PS.  I will also be forced to do some credit repairs and other stuff in order to pay for mine when the time comes so I am working on that NOW.  The links Dx gave you are fantastic. 3rd - Work with your surgeon.  As bad as you want to get the PS done, the surgeon wants the paycheck.  (S)He is gonna do whatever it takes to get you legally approved.  Even if you have to flap your skin to the tune of Yankee Doodle Dandy while doing the Hula....do it. 4th - Above all.....hang in there.  Anything worth doing is worth doing right and it will come to you when it's time for it.

One of the blessing of OH is I started documenting rashes and other skin issue with my PCP earlier this year inpreperation for any possible plastics. If you do get caught at least they bois is jail will appreciate all the work the Dr did.