Insurance advice wanted--United HealthCare

 I'm a year out from my VSG, and starting to think about plastics.  I had hoped I wouldn't have that much loose skin and wouldn't need/want it, but not the case....

That being said, any advice for getting United HealthCare to cover the procedure?  When I talked to them, all they would tell me was "medically necessary and would be reviewed by their board".  Not so helpful in knowing exactly what criteria I need to meet.  Anyone have experience with UHC?

Hello,

Do a google search for United Healthcare coverage determination guidelines exactly. The first thing which comes up should be Medical and Drug policies. Click on the first one, then agree, then look under C for cosmetic/reconstructive procedures. This should give you the qualifications for cosmetic/reconstructive procedures.

Review what your policy from work says. Each policy can be different and what it allows or excludes. I just read mine - United Healthcare today (cuz I was bored) and it said it did cover reconstructive surgery. However under exclusions under weight loss/weight related it excluded abdominalpasty and panniculectomy. Wow, so glad I had mine done over a year ago when I still had BC/BS or I don't think mine would be covered.

Congratulations on your weight loss. You are not alone and many patients require plastic surgery after significant weight loss. Insurance companies will cover a panniculectomy which is a simple removal of the hanging part of your abdominal skin. It is not a tummy tuck where there is a tightening of the muscle wall and transposition of your belly button. If you need these things then your palstic surgeon may require an additional charge above what the insurance company will reimburse. Most insurance companies require documentation over a few months that you are having a medical probelem as a result of your skin excess. This includes rashes, ulceration, chronic infections or panniculitis. These have to be resistant to conservative treatment with prescription medication. In addition to this documentation, they will often want to see pictures of your abdomen. A general rule of thumb is that if your abdomen touches your anterior thigh on side view and/or it covers your genital region you have a good chance of coverage. Every company is different and in my experience UH can be tough. Best of luck.