Question of Insurance Gurus...
Okay...looks like we'll have insurance for another year. It's imperative that I get through any all plastics before then - assuming one iota is covered. So I've been cruising through the policy...here is what I've found:
This is under Exclusions and Limitations:
This is under Exclusions and Limitations:
· Cosmetic surgery and cosmetic services or devices, unless for reconstructive surgery:
- Resulting from a bodily injury, infection or other disease of the involved part, when functional impairment is present; or dependent child which resulted in a functional impairment.A functional impairment is defined as a direct measurable reduction of physical performance of an organ or body part. Expense incurred for reconstructive
psychological condition are not covered, unless the condition(s) described above are also met.
And then I also found this under Exclusions and Limitations:
Surgical procedures for the removal of excess skin and/or fat in conjunction with or resulting from weight loss or a weight loss surgery
I have skin irritation documented as well as that my shoulder bones are dipped in due to the digging in of my bra straps and back pain. Just not convinced this is going to be enough - or if I even have a chance in hell to begin with.
Any thoughts or suggestions?
Jana
HI Jana,
I've worked for a health insurance company for 22 years and normally anything listed specifically as an exclusion like you have listed above is not covered, nor is it appealable once the approval is denied. They deny 'based on the exclusion' and that's normally the end of the road.
NOW...with all that said, every insurance company is different. You should call your customer service and ask them if the surgery could be covered if deemed medically necessary.
Best of luck!
I've worked for a health insurance company for 22 years and normally anything listed specifically as an exclusion like you have listed above is not covered, nor is it appealable once the approval is denied. They deny 'based on the exclusion' and that's normally the end of the road.
NOW...with all that said, every insurance company is different. You should call your customer service and ask them if the surgery could be covered if deemed medically necessary.
Best of luck!
Phyllis
HW 314, SW 287, PS Weight 198, CW 181
Panniculectomy/Anchor TT 06-10-09
7.4cc in 10cc band
HW 314, SW 287, PS Weight 198, CW 181
Panniculectomy/Anchor TT 06-10-09
7.4cc in 10cc band
...exactly what redhaired said. I've found it difficult to get around exclusions but if you've been to the doctor repeatedly for skin infections and can get the clinic notes and prescriptions to prove it, they may consider it.
John LoMonaco, M.D., F.A.C.S.
Plastic Surgery
Houston, Texas
www.DrLoMonaco.com
www.BodyLiftHouston.com
Plastic Surgery
Houston, Texas
www.DrLoMonaco.com
www.BodyLiftHouston.com
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