kaiser..and plastic surgery????

hi all...

im only 9 weeks post RNY, but i know i will need plastics in the future for my panni...
and my saggy boobs..=(

so im already researching and looking into self pay methods,but iwas thinking..

Has anyone with kaiser insurance has their PS covered?
even tho i work for kaiser , im not familiar with the PS requirements, and im too embarrased to ask them ( as an employee)

anyways if u have had any coverage or denial from kaiser can you please share youe expirience..

thanks so much...

BoRiCuA408

A lady on here had lots of work done through Kaiser....Abindingbyhim is her screen name. Look her up and ask here the details....I have Kaiser also but payed privately to have my vsg. I heard that if your Doctor sends a referral to Dr Lee in west la at one year out. You could then be seen by him and then he would determine if you qualified for surgery. I AM GOING TO TAKE THE AVENUES AND IF ALL ROADS LEAD TO KNOW WHERE I WILL PAY AGAIN OOP.

I had a breast reduction done through my Kaiser insurance many years ago. (12 to be exact)  It turned out great & I loved it! 

Then, years later, after a massive weight gain, a gastric bypass & weight loss, I found I needed plastics again. The head of the plastics Dept was my Dr. Kaiser would not do a breast lift, arms, face neck or TT. They would do a pannulectomy, which is the removal of the hangy skin on my belly but no tightening. I didn't want to go throgh the pain & recovery from surgery if I couldn't also get the tummy muscles tightened. I felt I had no choice but to self-pay.

Now I have read on the forum of quite a few that have fought back & their Kaiser did pay. Although I had documented my need for plastics through many Dr appts & pictures, I guess I didn't fight hard enough. It CAN be done but maybe I gave up too easily.

Document!!  With doctor appts & pictures. And get ready for a battle!! 

PamT

California patients, including Kaiser patients:

No matter what you do, request a consult with a plastic surgeon before you go ahead and self pay.  If you have Kaiser, ask them first.  If they deny you, you should get a consult with an outside of Kaiser plastic surgeon, and get them to write a letter using the template letter I have prepared which tracks the California law that MANDATES coverage of reconstructive surgery without any medical necessity requirement.

I am currently involved in a class action suit against Health Net to enforce this law.  There is a copending case against Blue Cross.  When the dust settles, there will be requirements that should enable people insured under plans delivered in California to get coverage for their reconstructive surgery work, so long as they have
   1) abnormal structures of the body
   2) caused by (among several things) a disease, e.g., morbid obesity
   3) for which reconstructive surgery can provide EITHER improved function OR improve appearance to the extent possible (NO MEDICAL NECESSITY REQUIREMENT!)
   4) and wherein such improvement is more than minimal.

But if you never gave your insurance company, including Kaiser, a chance to say "yes" (even though you know they won't), you forfeit your right to get reimbursed when this all settles out.  So make sure you get denied first.

WOW...

thanks i didn't know that..i will give kaiser a shot to deny me first..lol..

I'm not there yet but this information will def. have me prepared before my battle begins,,,

i feel that they should pay for it of your body is " deformed" from massive weight loss especially if u had a wls..because obesity is a disease,
thanks for the replies..

BoRiCuA408

HI

I have Kaiser in Northern Cal. I asked for a simple skin removal and was not only denied but when I filed a appeal Kaiser flat refused to allow me any input at all. Every step of the way was timed so that I would have absolutely no chance at presenting my case. It was horrible. Now I am facing a Spinal Fusion because of the pull of my panni on the spine. Seems like they would rather perform spinal surgery then address what I believe to be the real problem. Of course their first choice was to have me live on Morphine the rest of my life. I am so depressed about this but I just want the pain to stop I don't care what they have to do. I am convinced it is the pull of my panni keeping the area inflamed and painful. Kaiser does not play fair in fact they play dirty, Good Luck!
                                                                                                              Nancy

I had quite of bit of my initial plastics covered by Kaiser ---- BUT I'm is So. Cal Kaiser which is very different from No. Cal Kaiser.

Here, they will pay for your panni removal, and for me, they covered my breast lift.  I went thorough West LA, which also allows you to pay a fee for other plastic surgery which is not covered.  I upgraded my panni to a LBL and I paid extra to have auto augmentation of my breasts using my tissue.  Kaiser will not use implants except in the case of breast reconstruction following diseased breasts.

My understanding is that No. Cal will not cover the panni removal.  I would appeal to member services and to the California Department of Managed Care.  The panni is a health issue and should be removed.  Keep in mind that a panni removal is not considered cosmetic, and they just lop off the extra skin -- but at least it is gone.  I do not know if you have the option to see if you can do this through So. Cal - I wouldn't think so, but that might be an option too.

Good Luck -- I would really love to see the No. Cal people band together and get in on a complaint to get this covered.  I had a friend who was approved here, then moved and cannot get the skin removed there -- really strange.