Anyone approved for a panniculectomy, even though they didn't meet the exact policy...

Reading Tom C's post about his insurance approval got me wondering what the language was in my policy regarding plastic surgery.
It is covered when:

Pannus hangs below pubis (supposedly needing pictures to document),
AND you have a rash, infection, cellulitis, or ulcer that do not improve with treatment for 3 months, OR there is documented issues with mobility or interference with daily routine,
AND that your weight needs to be stable for 3 months, and IF a bariatric patient, you're at least 18 months post op, OR have a stable weight of 100lbs lost, or more, for 3 months.


Now, my pannus doesn't quite hang that far.  I don't really have any rashes, but my belly button does get a rash sometimes, but it's not documented anywhere.
I have been at a stable weight for 3 months, 150lbs lost and I'm almost 18 months post op RNY.

What do you guys think?

Are you sure you don't have any rashes, sometimes a little healthy scratching can get you there. ;)  I had about 6 months of documentation for sores and attemps of healing via cremes and ointments perscibed by the doctor.  After this we submitted for approval.

LOL....thanks.
When I get the rash in my belly button, it does itch.  It happens once an awhile.  Nothing that I normally would go to a doctor about....but maybe I should now.
I would feel like such a baby....but I guess I can tell her that I just need these occurences documented.
Mine's only for 3 months...I guess I can do that.
I wonder how often I need to go?

Also, thanks to your posts I looked even further in my policy, using your terminology and funny enough, brachioplasties are covered too!  Only those 2 procedures, though.
Specified the other normal procedures, that we might get, as exclusions.
I'm going to get on it!

Check with the surgeon but I went monthly to take pictures of my rashes.

Julie

i will tell you that when i went for my ps consult, he told me he didnt think i would get approved because it didnt hang down far enough and i didnt have enough documented infections. i had my bariatric doctor order me cream i think once or twice. i would get some rashes but not alot. i would mention it at my appts and see if they will order you some cream. the insurance companies will run a check of your prescriptions...most of the time i used otc powder. my insurance company did cover mine

I haven't decided on a surgeon yet.  But I do have an appt with my bariatric surgeon this month, I think I might mention it.  And I need to make an appt with my PCP, and I'll mention it then too.
It's just really for 3 months, I can manage.  I wasn't looking to have it done until the end of the year anyway.  Maybe I'll lose a little more weight in my belly and it'll hang lower!

Thanks, you give me hope!

Go for it cuz it can't hurt to try now that you know the conditions and you fit most of them. If it was documented that is something better than nothing.
Although I live in Israel, there are four HMO and differences in medical coverage between them and if you pay extra or have an extra insurance.
I never fit all the criteria for the Plastics but I guess enough such that when I appealed-I won!
Do not give up cuz you too might be a winner.
Mikimi in Israel

I think I will just go for it.
I had no kickback with my approval for weight loss surgery. I was approved in less than a week, and needed no extra documentation, etc.
Doesn't hurt to try!

Thanks!

I had a tummy tuck and hernia repair done in January and  a revision with a mons lift/reduction in June.  For the January surgery i wrote a letter (very detailed and personal) outlining the issues my panni was causing (rashes were only a slight issue and I had no ongoing documentation for that).  My insurance approved it in 3 days!  For the June surgery, they initially declined approval, but my plastic surgeon did a peer to peer review and got it approved.  I was impressed as the mons lift/reduction procedure was not part of what they say the cover.  Whatever surgeon you go with, be sure they are willing to "go to the mat" for you; several times if necessary.   I discovered that just because it is not listed as covered, doesn't necessarily mean it isn't and that no doesn't always mean  no.

If you would like to see a copy of my letter, feel free to PM me with your e-mail address and I will forward you a copy.