Word to the wise

Hi everyone, TGIF!  I just wanted to share some things.  I know what courage and determination it takes to lose weight the way we are doing it.  I have been doing this for 3 and a half years now and truly love the new me.  But a time has come, even though I'm not a goal weight, that I really need to have some plastic surgery done to remove some of this excess abdominal skin.  When I started losing weight, I literally did it by myself.  Joined Curves, bought a treadmill and off I went-slowly but surely.  My doctor was involved limitedly (regular checkups,etc.)-and for that I am having real problems with my insurance company.  Everytime I send in something they ask for, I get another letter asking for something else.  I have been going back and forth with them for  8 months now to get approval for a LBL. I called them on Tues.  to try to get updated on a decision and talked with 3 different people for 2 hours.  The last woman I talked to told me to call someone else--and I just lost it.  I started crying.  A blubbering, snotty, wiping your eyes and  blowing your nose cry.  It was my breaking point. I just felt like I have worked sooo hard to lose this weight the healthy way and now that I am asking for insurance to help me, I have to go to China and back.   Anyway, I pulled myself together.  I'm fine now and ready for the next round.  BUT, for everyone who might be considering PS after their weight loss, please make sure your doctor is documenting everything that happens to you---weight losses and gains, infections/rashes under skin folds, pains, aches, etc.--because insurance will want to know everything. (Did you have to go through this Donna and Andrea for your PS?) Thanks for letting me vent a little, katy

Thanks for sharing.  I'm sorry this has happened to you.  This is exactly how I felt when I was denied over and over by Blue Shield of California for bypass surgery.  I was 320 with a BMI over 50 and several co-morbidities.  To make a long story short the insurance covers this procedure if medically necessary but told me I wasn't a good candidate for long term success.  No real reason given that made sense to me. They asked me if I ate past fullness and when I said yes I wouldn't be this big if I wasn't eating past fullness they said I wasn't a good candidate. They were real jerks.   I fought for two years with them.  I have gone on to lose 105 pounds without surgery.  I still need to lose at least another 50 pounds.  I do have some sagging skin and I occasionaly get a rash under my stomach.  I will defenitely let my doc know about that.  I have no hope in my insurance to cover plastics since they wouldn't approve the surgery but the time will come when I will start inquiring about it and I need to have all that documented stuff.  Besides the rashes when it comes to plastics what other things should I start having my doctor document? Stuff like odor or sexual problems?  I want to start that paper trail now.  Do they consider aches and pains for plastics?  Do they have to be related to the excess skin?  Thanks for your input. 

hi katy -  i'm sorry its been so difficult for you. dealing with insurance is such a pain in the neck. i can tell you though from my years of participating on the PS board that it seems rare to get insurance to cover anything more than a pannilectomy (a tummy tuck if you are lucky) - neither of those would include the back part of the LBL - or breast reduction. they look at it only from a functional perspective, which is why the panni is the easiest thing to get approved. that makes a huge difference in daily life as opposed to a saggy butt or flapping arms.  its getting harder and harder for a number of reasons:  there are so many more ppl getting WLS and therefore way more requests for plastic surgery - i know in one state i lived that there were not longer covering WLS for ppl because of fallout PS afterwards. and frankly, i'd rather have them covering people who need WLS than PS. there are also people abusing the system by "creating" rashes in order to take pics and get coverage. insurance fraud is not the way to go. it also seemed like people who don't have WLS have a much harder time getting things approved regardless - that just seems like the way the health care industry works - they don't like preventative measures - even though losing weight naturally saves them a lot of money. i have heard they always deny you on the first try no matter what and then you have to go through the appeals process. and then there are just some companies that won't pay for anything no matter how much you try. there are other ways of doing it though - leaving the country is much cheaper (albeit riskier sometimes) and there are many things you can do with financing, 401K etc. one woman who was denied multiple times just started saving up - skipping a pedicure here, packing her own lunch there - and everntually she saved up enough to get everything done. i was post over on the PS board to see what other ideas are out there. i had to pay out of pocket for everything, but there are people over there who know more about the insurance issues and how to do appeals and all that. i'm sur enothing i have said has maed you feel any better but don't let this discourage you. you have done something amazing in losing the weight on your own and nothing should take away from that - even obnoxious insurance drama. i'm sure that if you keep at it, maybe explore some other payment options, that something will come through for you.

Hi Katy, I am so sorry for your experiences.  I know how horrible it is to get to this point and realize that you have another battle to fight!  I wish insurance companies would be a bit more understanding, but it's a numbers game and frankly it's not in the cards for them to pay for what they think is all about our looks. I had like one conversation with my insurance company about plastic surgery .  That was one too much.  I went back and forth for a while figuring out how I would get the money.  I stumbled upon a residency program here in NYC and the rest is history.  I have had an arm lift and a LBL and paid a little over $5,000 for both of them.  I am planning a breast lift and augmentation in the summer and my PS is starting to talk about a thigh lift but I'm not convinced of THAT yet.  Both will cost me under $5,000.  Residency programs aren't for everyone but the surgeon I ended up with is a real professional and I adore him. As Andrea said, the panniculectomy is the most approved procedure.  Breasts can be approved if they are proven to hinder your every day life.  Beyond that it's a huge documentation struggle.  Funny thing about some insurance polices.  It says that if you lost 100 pounds or more through bariatric surgery then  you'd definitely be approved for a panniculectomy.  Ironic isn't it?

Hi guys, Thanks for your responses.  They have already said I would not be approved for the back and butt/hips part of the LBL, but needed more doc. for the panni.  So, right now I'm still willing to fight, but I really think for my emotional health, i am probably going to just end up paying for it myself.  I truly do not mind taking out a loan.   I will definitely look into residency programs.  That's a great idea Donna, which one did you use and how did you find out about it?   Mama, I would document everything.  Tell your doctor to write it all down in his notes- even if you think it may be insignificant.  If it's a problem related to your weight or excess skin, tell it all.  It can't hurt. I'm sorry about your denial for WLS too! I am having a chin and neck lift done in the middle of June which I am very excited about ($3500-but well worth it).  So that will help with keeping my spirits high.  I do understand that insurance companies want documentation and I understand there reasonings, but I don't think it should be easier for a WLS patient to get PS then someone who did it NS.  I do think that's unfair.  I'm gonna keep fighting the good fight.  Damn those people who take advantage of the system! It does help to know others have been through this - which sounds bad, but you know what I mean.  Thanks for the encouragement and suggestions. Katy

http://www.aacplasticsurgery.org/programlistlist.html Katy, Here is the link to the residency programs in the US.  There is a board called www.plasticsurgeryjourneys that has a lot about overseas plastic surgeons.  There is a small board for residency programs but nothing huge. Good luck!!