Looking into plastics and have some questions...

Laurie D.
on 7/6/09 12:12 pm - minden, NE
Hi!  It was suggested that I post here and ask for some insight and maybe someone can help me out.

I have a small hernia below / in my belly button that isn't in need of a rush fix, but do have a large amount of skin overhang from my weight loss.  I have severe infections under my stomach, pubic line from 4 past c-sections and now that the skin is folding in on itself I have infected belly button as well.  Very painful. 

I have only medicaid and medicare coverage in NE.  I have been told two different things now, one from my surgeon (who actually didn't do my WLS but has taken over for my original surgeon) and one from the social worker with HHS.  Dr. says that they do the surgery and THEN get the approval  and payment, and thus his hospital requests that I sign a form stating that if the insurance doesn't cover the TT (or possibly call it a paniectomy?) I owe the hospital $3,000.  I know I shouldn't complain about the amount, but I am on total disability and there is no way I can come up with this cost.  The social worker said that the doctor has to have PRIOR authorization before doing the surgery and that likely it would be covered because of the infections I fight.  

I have also been told that there is no way it will cover having my arms done BUT the social worker said that it is possible due to the amount of skin I have hanging (pretty bad!) that they will ok it due to risk of severe injury.  

I know of a lady who had WLS many years ago, she had her arms and tummy tuck through medicaid / medicare, but I no longer know where she lives to find out how hard it was for her to get it done.  

I would love to know of any experiences and any suggestions about how to go about this. 

Thanks so much! 
SW 308/CW164/ GW 140
                        
dmoore1162
on 7/6/09 10:53 pm
Have you had a consult with a plastic surgeon.  The plastic surgeon is usually familar with the different critera for each insurance company.  When I was thinking of opting a different insurance company, I called the plastic surgeon I wanted to use and asked them.  They gave me very accurate information.  Even if you do not go to a plastic surgeon you can still call one and "fake" it. 

You other option is to call the insurance company themselves and ask them.  The hernia surgery will probably be ok, it's the other that may not.
Delores Moore
it's never too late
    
Laurie D.
on 7/7/09 12:33 am - minden, NE
I have contacted the PS I'm looking at, he has not replied (I emailed him, will call him if I don't hear back in a couple of days, just emails are easier for me this week lol). 

thanks! 
SW 308/CW164/ GW 140
                        
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