Did your insurance cover your panni?

Hi, I am new to this board - I am close to a year out and I've lost about 100 pounds in total and would like ot get a panniculectomy. I have rashes where the top part of my "tummy" and the bottom part rub together - and I am having pretty significant lower back pain now. I exercise - strength training as well as cardio - regularly and I had a breast reduction 6 months before my RNY - I thought that my days of lower back pain were behind me after my BR surgery - but here I am, having back pain again, and I think it is my exess stomach tissue that MIGHT be causing it - I am working on strengtheing my core to help, but I would LOVE to have a panni - so, two questions, 1. do you think a panni would help the lower back pain, and 2. how often does insurance pay for a panni?  THANKS IN ADVANCE SO MUCH FOR any info you can give me!!!!! Cindy

Whether or not insurance covers it depends on the policy with your company.  I have UHC and plastics were not covered unless a result of post-cancer reconstruction (specifically for the breasts).  Now someone else with UHC but a different company may have a policy that does not exclude it.

Your best bet, is to read your policy and/or call the insurance company.

Good luck.

I'll call my insurance company today. I have very good insurance. They covered both my breast reduction as well as my RNY 100%. I just didn't know if ANYONE'S insurance ever pays for a panni or any other reconstructive surgery after weight loss. I guess some people do get coverage, so that is good news :)

My insurance will pay for panni removal if it's deemed medically necessary. Of course that varies from company to company. From what I understand the diagnosis codes play a large role as well.

Lisa

Aloha- Depends on their policy. Aetna covered my panni , and I ended up having a more involved procedure- circumferential belt lipectomy ( lower body lift)- so the PS started and stopped timers when he was done with the pannus for surgery time, anesthesia, etc and I was reimbursed for the pannus  portion of the entire procedure ( $8K). You have to get pre approved, though, and each company is different in what they will cover as far as cosmetic procdures go. Find a surgeon willing to submit your photos, mneasurements, documented rashes and lower back pain- mine wouldn't have covered it for 100 lb loss ( had to be more that 150) or unless your pannus hung below your pubis. XOLori

We have BC/BS and it covered my panni removal. I had a simular weight loss to you.

Good luck!

Diana

I have BCBS of NJ and they paid for mine.  On my consultation visit with my surgeon he took pictures of my belly and submitted them to the insurance company.  I was surprised when I found out they approved the procedure.  I paid the balance out of pocket for the tummy tuck and breast.

Good luck!

Sherline

They will cover 100% of an abdominoplasty (is that a TT or a panni?) under these conditions:

"Panniculus hangs to or below the level of the pubis; and causes chronic intertrigo that consistently reoccurs or remains refractory to appropriate medical therapy that includes sustemic antibiotics, topical anti-infectives, anti-inflamitory medication and appropriate skin hygiene"

So, I made an appointment with a PS (the one who did my BR) after Christmas.  He got me coverage for my BR, so hopefully he'll be able to get me coverage for this!!!! :)

That would be the tummy tuck which is skin removal plus muscle tightening.  So, IMHO, that's the better of the two options.

Make sure that you have all of your rashes documented at which ever doctor treated you for rashes, etc.  You might want to call back to insurance and find out what specific documentation you need.

Do you have Aetna?  I did and this reads just like what mine said.  I asked about the abdominoplasty part and when you read further it's broken down into other procedures and only the panni portion was covered.....no muscle tightening.

Get on that documentation for the rashes!

Good luck!