OXFORD AND PLASTICS

As of last week I was only one month out, so I know I'm jumping the gun a bit, but I wanted to know if anyone who has Oxford (Freedom, Liberty, etc.) has had any success in getting them to pay for plastics? Thanks in advance!

I don't think it's jumping the gun at all. Forewarned is forearmed, they say. I can't help with that specific insurer, but in general, insurance companies will pay for plastics that are medically necessary. In other words, if you have a large hanging pannus (stomach) that causes skin rashes/infections that either recur or do not respond to treatment, then it would be medically necessary to have the skin removed. In that case they will only pay for the bare bones minimum of a panniculectomy. If there is a hernia they will pay for hernia repair. But abdominoplasty - where they work on both the muscles and skin - not usually. Basically, it's as little as they can get away with... and I'm sure they'll look for *some* way to wiggle out of paying... All the best to you! How are you doing? Irene

Hi, Irene--thanks for your response! I'm doing okay so far. I was back to work after 10 days--a little sore, but basically fine. The last time I was weighed at the doctor I was 25lbs down, so I hope to be down a full thirty at my 1 month check-up, which should be this week. How are you doing? From reading the boards I got the sense that what you are saying is pretty much the way it works. It's just with insurance companies, they're individual policies seem to have so much influence over how even the exact same procedures will be treated. I know with my RNY I was not required to have a psych exam, no pre-WLS diet, and was approved within a week. That's just the way Oxford is if you fit their criteria. I am only hoping (against hope!) that they are as liberal with plastics!

Heather, I had Oxford Liberty when I had the WLS 2-1/2 years ago. No hoops to jump through, nothing, I had my consult, was approved for surgery (denied first, forgot a piece of paper) and had my surgery - all in 60 days. I did inquire about plastics and yes, it is mostly for reconstructive stuff, but (remember this was 2-1/2 years ago) they were pretty cool about the reconstruction for weight loss. I have since remarried and changed to a different insurance (they've also been good, I've had a lot of complications and they've covered every one of them). Keep in close contact with Oxford (I always enjoyed that aspect of them, even with them calling me to "check" up and see how I was doing, in the beginning it was like once a week or so - VERY nice company to work with). Good luck on your journey. It is a wonderful ride. Kathy