Plastics covered

know most of us WLS peeps have to have plastics when it is all said and done.  I was wondering if anyone has gotten their surgeries covered by insurance.  If so what was your medical necessity?  Anyone with Tricare have any success?

Tricare approves the panniculectomy if you can document medical necessity.  I have to add that while many get approved -- a fair number do not get approval.  Tricare wants to know that the extra skin is making you sick so be sure that you get rashes and such well documented in your medical records.  They are also going to be looking for medical treatments and that generally means prescription medications.  So do not self treat any skin issues -- see your PCP --everytime you get a rash and it is never to early to start the documentation.

I am scheduled for tt on nov 18  bc&bs approved the panni removal, but my surgeon does the anchor tt so I had to pay out of pocket 3500 for the tt 
Natalie

Hi.

My surgeon just got me approved for abdominoplasty (scheduled for 11/23) in part due to rashes that I had photographed and been treated for by my primary and also because I have several large hernias.  Hernias are not uncommon with open GB patients.  I have BC/BS of MA and the approval was granted on the first request.   I have also had a breast lift and neck lift earlier this year but paid for them out of pocket. 

I have Tricare but did not have the 'medically necessary requirements' what they call a lightweight I suppose.

But i have read of a few people on the this board who have had Tricare cover some of their plastics. Maybe they will chime in...sorry I dont remember names. Sometimes the military hospitals that have PS departments have 'training periods' for their surgeons and people have gotten TT's for next to nothing. We were stationed at Ft Hood when they did that. Unforetunately at that time I was no where near ready for a TT (many years ago).

God speed in your journey!

After making an appeal with the help of an attorney I had my lower body lift covered by United Health Care. They disputed my 'medical necessity'. I had to get a letter wrriteen by my primary care doctor that spelled out in detail how having my panni with constant rashes was a 'functional impairment'. 

I have Tricare Prime, and I was told very clearly by my surgeon that I did not meet Tricare's "medical neccesity" guidelines....but...I go to an MTF so they do not need to seek that approval, and are doing it anyway for me.  If you live near an MTF they may be the easiest route to go.  Good luck!

BTW- I am paying out of pocket to have my BA done at the same time...no luck getting them to cover that at all, lol.