Insurance Questions - D'oh

Sorry about that earlier post - can you tell it got really busy here at work really quick?? LOL

Anyway - my insurance company did not cover my WLS due to an exclusion.  If I remember correctly (don't quote me!) Humana no longer covers WLS in Colorado - go figure.  I paid out of pocket and luckily had no complications, knock on wood.

However, now that I'm looking into plastics, do you think they could deny me because the plastics are "necessary" from WLS?  I called the ins. company and got the standard answer of "if it's medically necessary, we'll cover it."  However, I'm not sure how much about my WLS they know about; obviously they didn't get billings for the WLS surgeon, hospital, etc.  My bloodwork comes through under my PCP and the PCP sends the results to the WLS surgeon.  I'm imagining that they would say, nope, didn't cover the WLS so we don't have to cover the plastics.

Any thoughts?
Thanks!
Jana

While I can understand why you would make the association between them not paying for the plastics b/c they didn't pay for the wls I wouldn't do that to yourself.  Get a referral from your wls program or pcp to a few ps's and have them submit it for approval.  Even if you get a denial initially, appeal it.

Just b/c they don't cover wls doesn't mean they won't cover a panniculectomy.  If you are having medical issues such as rashes, boils, infections etc due to the excess skin they should consider it medically necessary and cover it regardless of how you got in that condition.  In reality, you could have lost the weight on your own without wls and be in the same boat as a wls patient.  So what should matter is if you are having significant enough issues b/c of the skin that would warrant them paying to have it remvoed.

Good luck.