If your PS is medically necessary, will your insurance......

cover it? I am 228 lbs down after a year and a half post op. I have alot of hanging skin and I was wondering if insurance will cover it? I dont know where to turn or where to go. I need advice.....

some insurance companies will cover based on the weight loss alone. others want documentation that the extra skin is causing you a problem, such as rashes, skin breakdown, etc. first thing to do is consult with your primary care doc and have then make note of any issues you are having.  then i would consult with a plastic surgeon.  many of them will help you work with the insurance issue. i would post a note on the WLS grads board as well as the main board for some feedback on a good doctor.   there are also ppl on the NJ board who have had plastic surgery and might have some suggestions. good luck, jacki

Thanks Jackie for answering my question. I am having problems with skin rashes and such and I need to talk to my pcp about it as well. I need to get the ball rolling on it and I cant wait to get this excess skin off me. It is becoming a huge problem. Love, Jenn

I have not been down this road yet.  I can only tell you what other friends of mine have said... First, DOCUMENT DOCUMENT DOCUMENT.  Every time you get a rash, go to your doctors.  Let's say he gives you a cream that works.  Fine.  Then you stop using the cream and it comes back.  Even if you have some of the cream at home, GO BACK TO THE DOCTORS.  That way he has to write a note about your rash.  Get pictures of it.  Also, if it is causing back issues or issues going to the bathroom, get that documented too. The more documentation you get, the better off you will be.  It's abut the only way to prove medical necessity. Best of luck! Pam

My primary referred me to a PS when I was at my lowest (160) and what I was told was very discouraging. First, he indicated that the only thing that would be covered would be the removal of extra skin.  There would be no reconstruction (to put my belly button back where it belonged, for instance) so I'd basically be quite disfigured. He then produced a pricelist for various surgeries.  Not in my budget. I'm not sure whether this scenario is the norm.  I'm hoping it's not and when I get back to goal, I'll look into it again with another surgeon, perhaps. YMMV, this was just my experience.

It all depends on your insurance and documentation and your doctor.  I used Dr. Capella for plastic surgery and his office did a great job of helping me to get my lbl covered.  My out of pocket was only $1,000.00.  I paid for my bl/ba and face lift myself, but have been documenting rashes and irritation between my thighs and hope to get that paid for by insurance as well.  For my thighs, I'm getting a letter from my gp, ob/gyn, and a dermatologist.  Capella's office gave me key terminology that I have requested the doctor's include in their letters.  For my lbl, I also got a letter from my chiropracter about the hanging skin causing back pain.  I included lots of horrible pics and a letter describing how unsanitary the excess skin was, how it interfered with normal activities like sex, exercise, household chores, work etc.  Best of luck.  Sharon

like everyone else said -- documentation is key!!! go to  your PCP for every little rash or pimple or anything that is anywhere -- that was the advice of our PCP to ross --document everything -- then have a PS recommended by your PCP or surgeon -- you may also need clearance from your surgeon -- when you find a PS make sure they take your insurance -- we had that happen to us -- went to the office and filled out the paperwork, made the appt, gave them ross's insurance card -- waited the 3 months for the stupid appt -- found out as we were walking into the exam room that they didn't take his insurance -- HELLO you tell us NOW?????? i was a little mouthy after that -- but we learned a lesson --not all PS surgeons take insurance -- most of it is self pay -- so there is alot of homework to do -- word of mouth is a great advertisement also :)  good luck roberta

i know that my insurance use to cover it under doctor's recommendation........however, when i got my written approval letter for my surgery back in feb......they made it clear it's NO longer covered......nice. i'm certain there still may be ways around it...it just don't know them!! good luck!

Turn to your insurance company!  They work for YOU. I say call them and ask them this very question.  If they say yes, ask for the guidelines as to what constitutes "medically necessary" and get them in writing! Good luck!    I know I will be researching this before the end of the year, myself, but I want to be closer to my goal and more stable before I start worrying about this particular issue. Wendy