pannus removal and my health plan

I HAVE BLUE CROSS BLUE SHIELD OF TEXAS FEDERAL EMPLOYEES HEALTH PLAN BASIC COVERAGE. I HAD LAP BAND SURGERY IN 2007 AND SINCE THEN I HAVE MAINTAINED MY WEIGHT LOSS BY DIET AND EXERCISE. I WOULD LOVE TO HAVE A TOTAL BODY LIFT BUT I WOULD SETTLE FOR A TT AND PANNIS REMOVAL, DUE TO THE EXCESS SKIN AND THE RASHES I AM BEING TREATED FOR. I HAVE OTHER ISSUES WITH THIS AREA. THE RIGHT SIDE OF THE PANNIS IS MUCH LARGER AND HEAVIER THAN THE LEFT SIDE. MY UNDERWARE WILL PULL TO THE LEFT LEAVING THE PANNIS ALMOST EXPOSED. WHEN I WEAR SLACKS OR JEANS THE THE PANNIS SIDE ON THE RIGHT PULLS FROM THE LEFT, VERY UN COMFORTABLE FIT AND MY LEFT HIP HAS TAKEN FORM TO A MUCH ROUNDER LOOK NOW BECUASE I HAVE DEVELOPED OSTEOARTHRITIS IN IT WHERE AS THE HIP ON THE RIGHT SIDE IS FLAT AND NOT AFFECTED.. MY RASH IS ODD MAN OUT FR ME. THE SKIN UNDER IT GETS VERY RED AND SHINY WITH BUMPS THAT OPEN UP, IT GETS SWEATY AND SMELLY, THIS CONTINUES DOWNWARD TO THE CREASE IN THE GROIN AGEA ALL THE WAY DOWN TO MY PUBIS AND THEN SOME, I CANNOT GET RID OF THESE BUMS OR SORE SPOTS THAT GO DOWN EVEN FURTHER AND WHEN I HAVE TO URINATE THEY BURN. I USE WHAT MY DR. PRESCRIBED BUT IT ONLY HELPS A LITTLE. THE DR, SUBMITTED TO THE HEALTH PLAN A REFERRAL TO HAVE THIS DONE AND SHE SAID THEY WOULD COVER THIS SURGERY, SHE SENT THE REFERRAL TO A PLASTIC SURGEON AT A LOCAL HOSPITAL TO GO OVER, NO PICTURES NO NOTHING. I DON;T KNOW WHAT THE OUTCOME WILL BE CAN SOMEONE HELP ME SO I KNOW THE CORRECT STEPS THAT NEED TO BE DONE. THANKS SO MUCH

Assuming your insurance covers for skin removal, it sounds like the ball is in motion.  They may not need pictures to approve a referral.  Most insurance only covers the actual excess skin removal, not the tummy tuck portion.  You can generally pay the difference for the non-covered portion.

Best wishes to you and I hope you can take this next step.  I just completed plastics.  Never thought I'd want to do it, but I was so tired of the extra skin and the hygiene issues.  I'm so glad I did it now.  For the first time I don't think of myself as formerly obese when I see myself in the mirror.  Clothes fit like they are supposed to now!

My advice is to call your insurance company and find out specifically what they will cover and what information they need. Every insurance company and plan is different, and has different requirements. I have Empire Blue Cross (based out of NY), and they covered my full panniculectomy & abdominoplasty plus muscle tightening. All they required was pictures plus a note from my doctor saying that the pannus was affecting my walking, etc and that they had treated the skin infections for at least 3 months but they kept coming back. Good luck with it.

HELLO AND THANKS FOR YOUR RESPONSE. I DID CALL MY HEALTH PLAN YESTERDAY AND I WAS VERY SURPRISED BY THE ANSWER I DID GET. IT MUST HAVE BEEN MY DAY. I EXPLAINED THE SITUATION AND ALSO THAT MY DR. SUBMITTED A REQUEST FOR THE SURGERY. I WAS TOLD THAT THEY NEVER GOT THE REQUEST BUT ANYWAY. I WAS TOLD TO SPEAK TO MY BARIATRIC DR. ABOUT THIS AND TELL THEM HOW IT NEEDS TO BE WORDED AND FOR THEM TO SEND THE INFORMATION TO THE HEALTH PLAN AND YES MY INSURANCE DOES COVER THE COST OF THE SURGERIES BUT ONLY IF YOU HAVE LOST WEIGHT THROUGH A SURGICAL PROCEDURE. I ALSO WENT TO MY REGULAR DR.'S OFFICE TODAY TO OBTAIN A COPY OF THE LETTER THAT WAS SUBMITTED AND GUESS WHAT, NO LETTER WAS EVER WROTE NO SURGERY WAS SUGGESTED TO MY HEALTH PLAN EITHER. ALL I GOT WAS A COPY OF THE ACTUAL WORKSHEET THAT THE DR. USES AND ON THAT IT DID REQUEST THE SURGERY BUT IT LOOKS LIKE IT WAS NEVER SENT ONTO THE PLASTIC SURGEONS OFFICE TO BEGIN WITH. NOW I UNDERSTAND WHY THE LADY IN HER OFFICE LOOKED SO NERVOUS BECAUSE SHE WAS THE ONE THAT TOLD ME THE LETTER WAS SENT OUT AND WELL NOT!  I WAS ALSO TOLD TO MAKE AN APPOINTMENT ABOUT THE RECONSTRUCTION SO I DID THAT TODAY AS WELL. THE APPOINTMENT IS AN HOUR LONG AND WILL GO OVER THE ENTIRE PROCEDURE WITH ME. THANKS

I just recently had my pannus removed 32 pounds of excess skin and like you had all kinds same issues and I have Medicare/ Indiana State Medicaid which mine was approved and my surgeon also said with having a lot excess skin on my inner thigh close to my pubic area insurance will over also.. Pannus removed 11/26/12 as of now almost completely healed but with limited exercise I can do weight limit of 15 pounds. Hope this helps and any other questions here my email. ddeeeeanna@ yahoo.com

32 pounds?!?  Have you lost all of your weight?  My panni was good sized and it was only 6 pounds, but it was ALL skin.

Lora

No I having severe medical problems with my back and terrible rashes due it hanging down to my knees and mine was also all skin I have lost before panni removal 160 pounds after panni removal total of 192 I feel much better and now I can continue with my exercise and get down to m goal weight my WLS set for my body type..

I was just approved for both procedures 15830 and 15847 on Februry 27, 2013 and recieved my letter of documentation today. Now I have to have an appointment with the Surgeon before surgery to get my questions answered and setting up the date of surgery. I have waited such a long time for this and now I am in the excitement phase. Wondering well about everything more so what I will look like with having the excess skin hanging around and the tummy tuck. I guess time will tell. Thank you BC/BS Federal Texas for maing this all possible.