Medicare covering TT or other plastic surgeries

cojessmom
on 3/8/12 12:30 pm - MN

I am just 3 months post op but since starting the weight loss surgery program I have lost a total of 81 pounds and am now just 22 pounds from goal. My question is now that my body is changing so much I am seeing that to be totally happy down the line I will need a tummy tuck, breast lift, thigh lift/tuck whatever they call it .. etc I am just wondering what tips anyone has about getting medicare to pay for any of these procedures. I do notice that my back is hurting me worse now then it has in years and I think it may be from the hanging weight in front? Not sure but it seems to get worse as my sagging skin increases. Thanks for any advice. I know I will need to wait til I hit goal but I want to be prepared. 

Becca  

                                       Becca  Surgery date Dec 1 2011 
        
Andi190827
on 3/8/12 11:15 pm - Fort Leavenworth, KS
 I can't help you with Medicare coverage other then I know others have been approved. Doing research for plastics is great, no matter how early out. Knowledge is power. Also if your excess skin is effecting your health; back pain, rashes, yeast infections... make sure you go to your doctor and get it documented. Most, if not all, insurance companies will only approved if it is medically necessary. Documented medical problems will greatly help you in the process.
Good luck and congratulations on your awesome weight loss!
Andi
Andi Highest 278 lbs, Pre-op 269 lbs, Goal/Current 150/160 lbs
Currently looking into plastics...

Change the voices in your head... Make them like you instead.

Cherish F.
on 3/8/12 11:31 pm - Philadelphia, PA
Without knowing what Medicare covers I suggest constant documentation. And pics if you can.

I was in my PCP's office at 3 months out from my RNY.
I told her straight "You're going to see a lot of me in the next year. I'm going to have you document every pain, itch, scratch I have so I can work toward ps when I'm at goal and maintaining."
She replied with "So, you've had a rash right? Under your breasts? Let's document it."

I would faithfully go in every few months and we would discuss my back pain, rash etc. And she would recommend on OTC cream I should try and document it. Then the next visit I would say it didn't work, and she would document that. And so on. When it came time to submit to insurance she wrote a great letter saying all that I've had and that we've "tried". She's been flat out amazing!

In the end they approved my breast reduction. Simply because my stomach doesn't hang low enough by their standards. I'm ok with that and am going to pay for a tt out of pocket while having the breast lift.

Hopefully you have a PCP who will understand your goal and work with you.
 Cherish
Consult Weight/ Surgery Weight/Current Weight/  Goal Weight, Reached 4/7/11!!
     294                     286.5                     165.5                     164

Full abdominoplasty & Breast Reduction/Lift - 4/9/12!

Even miracles take a little time. ~ Cinderella

                
kipz303
on 3/10/12 4:40 pm
 I don't have medicare but I have Anthem Blue Cross Medi-Cal (california poor ppl insurance lol) My PS has me coming in Wednesday to take pictures for insurance submittal for a panniculectomy at the very least. (You can see my before pictures in the before plastics folder on my profile, pass is "plastics" i think)  He is very confident that I will not have a problem getting it approved since my MRIs and x-rays are showing that I'm developing a scholio-curve due to the hanging skin. It's making my life SO painful but they dont cover on back "pain" alone or if its "only to look better". The handbook also says they wont cover reconstructive if it "will only make a slight improvement in daily living" ...heck, I have 3 docs saying that it will make a tremendous improvement so lets hope!  I do get rashes if I'm not clean but it drives me nuts to not be clean. PS says I should get covered just on the amount of skin and what its doing to my back anatomy wise...I'll let you know how it goes ..medicare isnt that far off from medical as to what they pay for. 

 

RNY - August 13, 2010

LBL - October 29, 2012

 a total of 271 lbs lost!!

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