XPOST: Approved for Cosmetic Reconstruction

After months of pulling teeth, numerous letters written, documenting each and every little body and/or medical issue, 1st level appeal, then 2nd appeal, what seems like thousands of dr. visits, and many copays spent on exams, prescriptions, and what not...  BCBS has finally agreed that after losing 253 lbs, I am deserving of  having my abdominal area reconstructed.  They are paying for the panniculectomy and I am tossing in a little extra to have the abdominal wall tightened and some upper chest work done.  While they have not caved yet on the upper chest work (even though they claim to pay for gynecomastia for men who have loss excessive weight), I will pay be paying out of pocket for this and filing a claim and most likely multiple appeals in order to get some level of reimbursement.  I thought about waiting for approval on the chest work but for many reasons, it made sense to go ahead and have it done with the abdominal work.  1 surgery vs 2, they may deny me in the end anyway, my insurance is changing come Jan 1 and has higher co insurance levels, plus after having the abdominal work done, I may be too chicken to opt for more plastic work in the future. 

So on December 11, I will be going in to the hospital for a 6-8 hour procedure to rebuild my Dolly Parton / Jabba the Hutt figure into something that remotely resembles a male human being.  All kidding aside, I am truly greatful for BCBS, they gave me WLS and they are now giving me the cosmetic procedure.  They have given me my life back.  So on the Christmas card list this year, my WLS surgeon, my plastics surgeon, and BCBS all get top billing. 

This is a risky procedure (as was the WLS) so I am praying all goes well.  I think the benefits are worth the risk.  I would ask that you all please think good thoughts for me.  Hopefully I will come through with no complications and complete my transformation into the new and healthy me.  My plastics guy tells me I will be below 200 lbs no doubt within 4-6 weeks post surgery.  Never would have thought I would hear those words in my lifetime. 

Well, just wanted to share a little of my good news with you all and to wish you all a very Merry Christmas and Happy Holidays...

Dalton

All my best wishes and prayers go to you. I think you will feel a hundred times better.
253 pounds is great, way to go.
I guess you jumped thru all the ins hoops and are now cleared for take off. I don't blame you for doing both at one time and getting it over with.
Good luck,
David

Thanks David.  You know, the weight loss was easy compared to getting the insurance approval for this.  One thing I learned, if you are strong enough to survive the grief the insurance companies put you through as you  move through the process, and you dont have a specific exclusion for a procedure, most insurance companies will cave when you get to the 2nd level appeal.  At that point it becomes a state review issue by the insurance commission and individual members appeal board.  The insurance companies get dinged if the request  makes it that far and they find in favor of the member (which usually happens because individual members on the review board are more sympathetic to your needs that the corporate insurance machine).  Not looking forward to the pain of recovery but hopefully I'll have some good meds to get me through.

HEY D... CONGRATS ONT EH WEIGHT LOSE AND THE TENACITY OF FIGHT THE INSURANCE COMPANY..

MY INSURANCE PAID..I'M FORTUNATE.. I HAD THE LBL..WITH MUSLE TIGHENING..THEN LATER THEY PAID FOR MY THIGHS..IT'S A WHOLENEW WORLD....

I want to echo the sentiments of those congratulations for the surgery and your tenacity in dealing with insurance. I will someday face a similar challenge. Good luck on the surgery.

Merry Christmas to you!  Having PS and your insurance to pay for it - WAY TO GO!!

Keep us informed.  Hardly any men ever post on the Plastics board so can't garner much info regarding pain or scaring etc.  Would like to think it may be in my future but I can tolerate my sharpei bod for now.

Congrats, and kudos to BC there, at least ..  

 BC here in Texas still has in place their blanket exclusion against even any kind of WLS or other treatments, despite being sued many times over it .. 

 Let's hope Obamacare eliminates this "issue", once and for all ..     America might finally start getting thinner and healthier again!