X-Post: What do you do when your excess skin affects your daily life and career? You FIGHT!

Paul, a good guy who often "pays it forward" in our Chicago DS support group, was just featured in this great "Today Show" blog on his struggle to get insurance to pay for his facial plastic surgery after massive weight loss. He gave me his permission to post this story on OH.

http://today.msnbc.msn.com/id/45590135/ns/today-today_health /

His 240-pound weight loss has been incredible and life-changing, but the excess skin on his face and neck is negatively affecting his daily living AND his careeer. He hopes that his ongoing war with the insurance company will help others who will come later down this same path, maybe even YOU:

If you are struggling with this issue, fight your insurance company. Only a few years ago, body reconstructive surgery was not as covered as it is today. Things can change!

BTW, if anyone has any advice on fighting the insurance company, he'll take it. Send me a PM and I will get the message to him.

All the best,

Nicolle

Dr Sauceda is more reasonable than most PS in the states.  I'm not sure if he's done a neck/face lift on a man, at least not in our group here, but several other ladies have had face lifts after seeing my results.  He can email pics to [email protected] and at least get a quote.  He can fight his insurance later.  I think a facelift by itself is $6500, but when combined with other body work it's around half that.

I'm confused why he did not get the facial work done first, if it is so negatively affecting him as far as speech and drooling is concerned. Can he not get financing? My goal now is to pay off my own debts and get my credit score in better shape so that when I'm ready to get more work done, I can get a loan.

Laura

Agree 110% with everything you just said Laura!

Bubbzz

I think the issue here is not whether or not he can get financing but whether or not he SHOULD HAVE to get financing.  This is clearly an issue of reconstruction that has an impact on this man's daily life.  There is no reason that insurance should not pay other than they don't want to and they are trying to justify the expense as cosmetic when it is not.

I think many of us have run up against that with our surgeries when we experience horrific rashes and skin lesions or other significant issues that hinder our ability to fuction in daily life only to be told flat out  insurance doesn't cover this...we dont care that you have necrotic flesh wounds - or what have you.

I do not believe that PS should be covered on a cosmetic basis for anyone -  even weight loss patients.  I WANT my arms and thighs done, but I can't afford it and they don't cause me any health issues.  I don't think insurance should pay for these to be done because it's a WANT and is truly cosmetic.

I NEEDED a panniculectomy because I had significant chronic rashes and the medication cause extremely painful lesions to appear.  I believed that insurance should pay for that and I was extremely lucky that they did which virtually no hassle - my first request was approved.

I think this man has been able to demonstrate the NEED from a reconstructive point of view and there is no reason that this should not be covered for him or other reconstructive patients. This is not an issue of vanity it's an issue of quality of life.

Personally, I did not expect ANYONE to pay my way. I became overweight from the life choices I made. So getting rid of the excess skin is my own responsibility. I am fearful of insurance companies covering more and more because ALL of our premiums go up.

If I had $30,000 to spend on plastics and knew I needed body AND face work done, I would have gone to Dr. Saucedo. Period.

I posted this on the RNY forum, but am going to repost it here.

My problem is when people repeatedly complain over insurance not covering it or that they cannot afford it. We are responsible for our own financial situations, whatever they may be. Get a second job. Get an education and get a better job. Get out of debt and improve your credit rating and get a loan. It's all about choices.

And before anyone jumps down my throat about my views, I am a single mom of 2 by adoption with no baby-daddy. I managed to scrimp an save for 2 international adoptions (over $40K). I've also managed to get 2 rounds of plastic surgery. My goal is to pay off my second round of plastics and improve my credit rating so I can get a loan for my next round. I will do it. I am determined.

Laura

Laura - by your thought process insurance needs to stop paying for all smoking related illnesses, if your at fault in a car accident-insurance should not pay for your injuries - after alll they were your choices were they not? And of course anything else insurance can justify as your fault.  You got pregnant -  shouldn't of had sex -  not paying for your maternity care.

I don't think that people who pay insurance premiums should have to travel to Mexico or any other country to get NEEDED medical procedures.  I personally would never consider getting surgery in Mexico -  it's my personal choice and it's not something I am comfortable with.

The insurance/medical game in this country is utterly ridiculous.  When my son was born i was charged $70.00 for a tube of neosporin -  because that's what the hospital had to charge in order to get reimburse the $2.98 they paid for it.  All the prices on medical care in this country are jacked up and that is what is affecting our premiums!  Our medical/insurance system needs an overall and I am tnot talking about Obamacare -  which solved nothing

I simply cannot afford thousands of dollars in plastic surgery.  I have a Master's degree so I have an education.   I also pay $1200.00 per month in day care for my 2 kids, My husband is getting his PHD so he is also educated -  but we have student loans (which came along with that education -  at public states schools), we have a car payment (1 car family) we live modestly, my combined income before taxes is $86,000.00 (good money) and I am sorry, but I CANNOT afford it and I do not want to take out a loan for something that is reconstructive and impacts my health -  when i pay for insurance for that very reason.

I absolutely don't expect cosmetic procedures to be covered when they are truly cosmetic -  but that is not the situation for many people post major weight loss.

Kristie I agree with you 100%!! I am in the process of trying to figure something out on how to get my insurance to pay for reconstructive surgery. My body was not only left seriously morphed from the weight loss but also from having huge babies. I look good with clothes on most of the time but I am 32 and I look 92 naked. Although my PCP approved the recommendation for me to get plastics because he seriously believe I should have it, the plastic surgery in our group only submitted a panni and said I doubt it will be approved since it's not that bad and he saw that my boobs were looking like tube socks with tennis balls in them he said oh yeah it will be hard to get that approved period.

I have 4 kids, a job, school, and bills and financing it is probably out of the questions....Sigh

Laura,
I think you are 100% correct. I agree with you. I have worked hard, saved, and my family has cut back so that I can have the plastic surgery that I want. I abused my body for years and through surgery I paid for, I was able to lose weight.
I do believe that people who smoke should not have cetain things covered by insurance, We know the risks when we drink too much, when we smoke, and when we eat high fat, high sugar ffods. Our bodies pay the price, and why should everyone pay higher insurance premiums to correct the problems that we could have prevented in the first place.
The us has horrible medical insurance we are charged to much, we pay high premiums and we are basically ripped off, but  a lot of it has to do with taking care of illnesses and problems that we have created ourselves.
Paying for it, is all about putting your money where it is important for you.