Insurance Coverage for Panniculectomy

Hi-

Over the years i've lost 112#s naturally and I need quite a bit of work done....panniculectomy, tummy tuck, mons lift and thigh lift.  I'm just at the consult stage and I'm trying a new PS today.  His receptionist announced that "Insurance will never cover anything if it was natural weight loss--only if you had barriatric surgery."  This seems most unfair so I am going to try.  I have BC/BS PPO.  Finally the question...does any body have any tips for getting insurance to pay at least a portion of these procedures? 

Call me hopeful!

The receptionist is not quite accurate.  I've had WLS and my insurance will not cover ANY plastic surgery unless it is related to reconstructive work due to breast cancer or other surgically disfiguring disease.

It's not so much how you lost weight that matters, but how your insurance policy is written.

Good luck with getting insurance to cover any of it.

Good Luck on your surgery tomorrow. Let us know how you make out.

Dr. Lomonaco has written a couple of articles on getting insurance coverage.  You can find them on his website.  http://www.drlomonaco.com/about-houston-cosmetic-surgery.sht ml (Look under the patient resources tab)

Have you read your policy to determine if plastics are covered?  Some insurance policies cover plastics and, some do not, no matter how much weight one has lost or how one lost it.

Red

I have the same coverage... I was approved for $12K for tummy tuck... I had pictures taken by my doctor of rash... hint hint... dish soap will give you a rash... I ended up not using approved insurance as out of pocket was too expensive.

I went outside of the country for affordable total reconstruction... full body-lift w/anchor, breast-lift w/aug. My US quote for everthing I needed ranged from $70K-$90K...

I went to Dr. Quiroz in Mex... cosmedclinic.com

What is a rough estimate for what you paid and how did everything go?

My surgery and aftercare for 7 days cost $12K. The full body-lift is a tough recovery for anyone. I had dropped 190lbs. 10 lbs. of skin was removed.

Last Nov. I went in for a second procedure only because of the enormity of skin tightening. $600 charge... one night stay at Lucerne Hotel which I HIGHLY recommend. The fee was for operating room/and anesthesia.

Considering what my before looked like... my after is AWESOME!!! I'm very pleased with the professionals at CosMed. There were no language barriers. Starbuck's is around the corner. They provide medical passes to insure fast passage across the border.

Joyce is Dr. Quiroz' patient coordinator.

I have Fed BC/BS.  I had one Dr's office tell me they WOULDN'T pay, and another say they would.  Of course I went with the one that said they would - and they did.  Now - you'll probably only get the panniculectomy paid for.  The rest is on your dime.

Its all how the Dr's bill it - but of course, like the others' said, some insurance companies just don't cover it - no matter what.

Good luck!  Its a frustrating research project - but pays in the end if it works out.
 

i HAVE FED BC/BS AS WELL. IS THAT THE ONLY THING YOU HAD DONE WAS THE PANNICULECTOMY?

Lisa R. said it correctly that if your insurance is going to cover a panni at all it will be because (1) it is a covered procedure and (2) you prove it is medically necessary by documenting rashes etc., with your doctor.  Once you know that your insurance covers a panni you most likely will need to see your doctor monthly for three months having him document rashes or other medical issues due to the excess skin and make sure that he notes this in your medical records and that you get a pescription for treatment and get it filled keeping the receipt as proof you bought it.

So WLS weight loss resulting in excess skin will not be a reason for a panni it is the medical necessity of the excess skin from any weight loss method.

Good luck.

Jim Randall