Kaiser NorCal and Plastics

I have reached the stage where I am now seriously researching PS.  I have a lot of redundant skin on my arms, thighs, back and of course, belly.  I have actually had to pretty much stop my exercise due to the pain that I have from the flapping of the skin on my arms and thighs.  I feel sore and bruised all the time and have some lower back discomfort that I am attributing to the movement of the panni during my exercise.  Short of compression garments, I have not found anything that holds the excess tight enough that I do not have any ill effects from exercise.

I am a nurse and I work for Kaiser so we have really good insurance, but I don't think that there is a plastics benefit unless it is reconstructive in nature.  I recently saw a post referenced on the main VSG board about CA and plastic surgery coverage after WLS and really want to get more information on that as it was stating that the PS work we have after WLS is considered reconstructive by CA law.  If anyone has any info on this, please share.

In the mean time, I was wondering if anyone here has had plastics with Kaiser and was it covered...whatever you can share about your experience would be greatly appreciated.  I tried doing a search, but there really was nothing there.

Thank you in advance for your input. 

Prior to the VSG, during the overview meeting, we were told up front that Kaiser would not cover plastics, so we should start saving our money. That being said, you have lost a significant amount of weight and it is causing health problems. I would go to your PCP and ask him/her for referral to the plastic surgery clinic or reconstructive surgery clinic in your area. What they may cover is a panni, but not a total TT. This is all I know. They will do breast reductions for medical reasons, but I haven't heard of Kaiser paying for arms, thighs, etc. The two things that might be covered for medical reasons are a panni and breast reduction. The process starts with a referral from your PCP to a center that performs reconstructive surgery.

Hope this helps. I also work for Kaiser.

Gail

Thanks for your reply.  I saw my GYN yesterday and we talked about the pain issue and she sent a referral over.  They called me yesterday afternoon (of course, I missed the call because I was pampering myself with a mani/pedi at the time) and I called them back.  I had to leave a voicemail but the girl called me today and I have an appt for the 17th.  I was very surprised at how quickly this took place.  When I talked to the girl today, she said that they do get coverage for some of the procedures when it is really bad and causing problems. 

I was concerned about my panni being covered as it does not hang down over my mons (I have a cheshire cat smile thing going on) and I saw a post where someone said there were 4 sets of criteria for Kaiser to cover it.  Of course, I didn't have a one of them.  But, I do get rashes if I am not very meticulous in my hygiene and I have bruises on the insides of my arms and thighs and on my back.  I roll over in my sleep and am awakened with such pain from the skin rolling up and pinching me that I bolt up out of the bed...it is a pretty intense pain.  It is dangerous for me to jump up like that because of pressure changes and I have really come close to hurting myself with falls from severe dizziness.  Thank goodness that I do not have this happen more than once every couple of weeks, but it is scary when it does.

I will let you know how the consult goes and what they say about coverage.  Thanks again for your reply.

 Kaiser would have covered most of my PS but I opted to go self pay with Dr. McNemar in Tracy because I hated the way Kaiser wanted to break up every surgery and would only do the very basics.

After waiting for 7 years for this I wasn't about to jump through anyone's hoops to get what I felt I needed done on the schedule I was comfortable with.

PS is super personal, weigh all your options before you just take what insurance is willing to hand you.

I LOVE Kaiser, I was one of the first people to be approved for WLS in No.Cal with them and they flew me to San Diego o have my WLS done, but going out of network and the self pay route was the right choice.  I won't regret paying off that GIANT CHUNK OF CASH... Not really.  I'm worth it :)

Xo, Alicia

Thank you so much for your reply.  I am encouraged.  I have issues that I may not be able to work around and may not have much choice on where I can get the surgery done...or by who.  I feel that it is very important that a good job be done.  But, at the same time, I have such pain with working out that I have to do something.  Not to mention, the number the skin is doing on my self confidence. 

I really need most of it to be covered because money is a big issue right now and will be for a while to come. 

Thanks again for your reply and the information.

 It is my understanding that the best kaiser plastic surgeon is Dr. Hop Le in San Rafael.  He came and spoke at one of our support group meetings and showed slides from his patients.  Wow!  I had a consult with him.  My friend just had a facelift with him and it's gorgeous!

If I had the time and money I would have gone to him.  He said four surgeries.  Dr. Sauceda was 1/3 the cost so I went to Mexico.

I have been referred to Mark Price in Napa.  He has some work that you can see online so I will meet with him.  I will ask for a consult with Dr. Le if I don't like what I see and hear when I meet Dr. Price on Tuesday.

I may have to find another option if Kaiser falls through.  So, I may have to wait a LONG while and go your route.  I will have to wait and see.

 Good luck Sharon!  Do check out Dr. Le if possible.  He was amazing at the support group.

Congratulations on your weight loss.  I'm a Kaiser patient in Honolulu.  Here Kaiser operates The Aesthetic Center which is self pay for plastic surgery, skin care, laser treatments, etc.   I decided after 18 months I wanted to have an arm lift.  When I went in for the consult, the plastic surgeon asked if I was planning on having a TT and if so he could look at both areas at the same time.  I'd been having rashes under the fold of the excess stomach skin and when he saw it, he said he would recommend Kaiser pay for it which they did!  It was an extended TT.   I've had a number of self pay procedures at Kaiser - the price quoted was half of what I'd been quoted by other surgeons.  I was very happy with the all aspects of the surgery - the staff, the hospital, the follow-up, and especially the results.

I hope that I am so fortunate.  Thank you for your reply and information.  I will know soon.