Feel like I'm being superficial & vain

I just read through the requirements by BCBSTN regarding TT. I doubt I can get it covered after reading this.  

POLICY

• Abdominoplasty/Panniculectomy/Lipectomy for functional impairment is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)

• Lipectomy for any other condition is considered cosmetic.

MEDICAL APPROPRIATENESS

• Abdominoplasty/Panniculectomy/Lipectomy is considered medically appropriate for individuals with symptomatic functional impairment if ANY ONE of the following criteria are met:

  • The individual's condition is beyond normal variation in body morphology with impairment of hygiene (e.g., recurrent skin infections, chronic rashes, uncontrollable intertrigo, subcutaneous abscesses) that is refractory to medical management

  • Panniculus hangs at or below the symphysis pubis, as demonstrated by pre-operative photographs (color photos preferred)

  • The individual has documented panniculitis

I have BCBS and I was able to get a TT covered without any problem at all.  Only stipulation was had to have lost at least 100 lbs.  I did't have any rashes or anything either.

Good luck to you!

I have BCBS as well...but there's no way I'll lose at least 100 lbs.  I'd only weigh just over 100 lbs if I did.  Man, I guess that counts me out of the insurance loop.  Back to self pay.

Not necessarily - I have BCBS and they're paying for the panniculectomy - I'm upgrading it to a full TT.

It hangs below the pubis - I too don't have a large panni - but enough i don't want to see it anymore - the surgeons office said "no problem"... I haven't lost 100 lbs but they said "a significant amount".

Find a surgeons office that will work with you - I called another that participated with my insurance and they said it wouldn't pay - but the one I'm going to said they will... it all depends on the Dr's office and the ones that do it a LOT know how to bill it.  Its not fraudulent -they wouldn't risk their license or risk losing their relationship with the insurance company to get someone through for a few dollars...

It can be a very difficult decision to make and or justify... especially with the economy so bad right now.  I have never been a vain person.... if I had been I wouldn't have let myself get to 300+ pounds!!   I just had my second round of PS....  My first round was in July when I had a face/neck/brow lift and a week ago yesterday I had BL/LBL/butt aug done.   I still have one more round to go hopefully this summer for an inner thigh lift and possible BA. 

My decision was based on the fact that all my excess skin was like a scar to me when I looked in the mirror.  It was a daily reminder of what I had done to myself, and it was almost as if my body (skin) was taunting me saying... hahaha  all that weight you lost will be  back and we are just hanging around until then!!!!   

Most non WLS friends don't understand why I'm doing all this... they think I'm nuts!!!!  But then they haven't seen me naked!!!!

I have been so happy with my decision to have PS.... I finally feel like the me that was always there but no one ever saw.

Best of luck in your decision!!!

It's a hard decision for me cause I have little kids and keep wondering WHAT if. I do have the skin issues and would like to think if I didn't it wouldn't matter but if it did it did. You deserve to have the body you want after all this work.

Hey Jen - I remember you and I corresponded when you were trying to decide on the VSG because I too was a light weight like you.  Well guess what I don't have any major skin or boob issues but I just want to make it all better so I'm getting PS.  I'm going to Dr. Sauceda in Monterrey Mexico.  Lots of gals on the PS board have gone to him and I've seen his great results. And, like the VSG in MX, his prices are half or less than US Plastic Surgeons.  Women always take care of everyone else.  I've seen how much more confidence I have now that I've lost weight and although PS won't change my life, it will help me to be even more confident.  I want to look as young as I feel!

I'm getting some face work done, brow lift and upper an lower eye lid lifts plus fat grafting to my marionette lines and lips.  I will also have a Benelli (donut) breast lift and augmentation and some lipo to my stomach and thighs.  If  needed I will return next fall for a mini tummy tuck and small thigh lift.

I don't feel guilty about doing something for myself but I was concerned if going through the pain and risk would be worth it given I don't' 'Need" PS.  After talking to many gals on this forum and thinking long and hard about it, I decided to go for it.

Tamera

Surgeons make BIG bucks doing Mommy Makeovers which are basically the same surgeries we have with WLS!!!  You deserve it, believe it :)

I have BCBS of NJ and they paid for my tt without documentation of rashes or letters from other physicians.  My surgeon took pictures of my breast and belly, BCBS denied the breast lift but approved the tt.  So my advice to everyone is try at least once to get approved, it can't hurt.  Also I lost less than 100 pounds too and my panni did not hang over my pubic area which was one of BCBS requirements.

Good luck.

Sherline

Thank you, Sherline.  I guess it would be worth a try.  I've had very good luck with my insurance company so far.  I did self pay for my VSG, but that is because my BMI was below 35...no insurance company is going to cover WLS for a BMI under 35 & I knew that going in.

Maybe I'll get lucky & the surgeon will know how to take good photos to make my tummy & boobs look real bad!    I'd really rather do any PS locally because I have 4 small kids that I would hate to leave for 2 weeks.