questions about insurance

I am about 10-15 lbs away from my goal and I am having issues with rashes and things due to excessive skin. I was wondering how I would go about getting my insurance to pay for a tummy tuck. I have KY State insurance, Coventry Cares of KY, and I am not sure if they cover these procedures. I am wondering if anyone has dealt with this company and what steps do I need to take to get to the point to apply for them to cover it. Thanks in advance for any and all of your help.

I don't have your insurance but I know with mine I have to have documented by my primary care doc 6 months of rashes or skin disruptions.....that won't heal or keep coming back after the use of creams and such. Make sure you include that your hygiene suffers.....you must take 2 or more showers a day to deal with smells etc. Further, you may have back aches or back problems or mobility difficulties with exercising due to the hanging skin. Also, my PS told me to take pics of all rashes etc. to help with documentation to send in to the insurance company. I am on month 3 right now. This type of surgery would not be considered cosmetic but instead be covered as reconstructive surgery due to medical necessity. So when speaking to your insurance company do not ask if cosmetic surgery is covered.....ask if reconstructive is covered due to medical necessity.

I hope this helps. I'm sure others that have already been through it will come along and chime in to give you more advice.

Good luck,
Kathy

After reading this post I am interested in asking what in surance you have... I did what you have said in the post and was denied and am being told I should appeal...I have Keystone Health Plan East and am using Dr. Lam.

Thanks, I will start with my PCP. I had talked briefly about some issues with my surgeon during my last check up, but sadly, i dont hink he documented it. I will however, make an appointment with my PCP and see what she suggests. She is generally very helpful and tries her best to accomodate my insurance needs. I just dont think she knows a lot about the issues that we have as banders or WLS patients in general. It just isnt a common occurance in her office. I was hoping you gals/guys could give me a direction to look in.. especially since you all have been there.. Thanks a bunch.. I appreciate your insight..

 Have you called your insurance company to see what their requirements are or if your policy even covers it?  Many won't unless its specifically job related.  I have BCBS of MI and they will only cover abdominoplasty for bariatric patients who have lost over 100 lbs.

My advice - call your insurance company and ask.

Dawnie.........I too have Dr. Lam. My insurance is Highmark Personal Choice Blue Cross/Blue Shield. I have not put in to my insurance yet for coverage but Dr. Lam told me what their requirements are for coverage so I knew what I had to do. When I went to him for a consultation I had terrible rashes that he took pics of under my breasts and under my belly. I also have been taking my own pics. My primary care doc suggested plastics for me when I went to her about my rashes. She sent me to Dr. Lam. I won't be able to put into the insurance company for coverage until I have completed my documentation of 6 months of rashes. It is very sad to me that Dr. Lam's office is not helping you with an appeal. I would call back if I were you and ask to speak to someone there who could tell you the procedure for putting in for an appeal.

Good luck and let us know what happens. By the way I went to Barix too for my RNY. Do you go to the monthly meetings for support??? There are a lot of people who go that have had plastics and might be able to further help you out.

Also another thought....Google....appeal letters foe insurance company to cover TT.....some people have put online their letters that they won an appeal with. Hope this helps. Keep in touch.

Kathy

There are places where you can donate your excess skin. Try to find a Shriners (dunno how to spell that) or something that cares for burn victims. They are always looking for donated skin.

 

This is a very old thread and they most likely will see this but, I am glad you brought it to light as I was just thinking about this.  I see my surgeon Friday again and will ask him about this as I see on a web sight he does reconstruction/burn surgery also.

We have a local hospital with a major burn unit.  I am not having surgery there so not sure if it can be transported and used.

Edited to add I talked to my surgeon today and he said they company that used to collect the excess skin stopped two years ago.  The reason being the skin is usually too thin and in poor shape to be used.  This is sad as the skin on my thighs is in GREAT shape and texture just to much.