insurance approval

I had gasric bypass Feb. 16 2012. I weighed 405 pounds when I started. I weigh 230 today. My gastric bypass surgeon told me I was probably thru losing weight since I have basically stopped losing since Sept. I had a goal of 180 but he feels like I will be lucky if I lose 10 pounds in the next year even with serious diet and excersize. I went to see a local PS about a month ago to see about a TT. I have around a 10 inch overhang of skin and fat that only lacks a couple inches of touching the tops of my knees. The PS said it was one of the most serious cases he has seen and that he had only done 1 that was worse than mine. He said that he would be removing between 20 to 30 pounds from my abdomin. We took pictures and he felt confident that I wouldnt get denied because of how bad it was. WRONG I was denied. My PCP retired this past Feb. so I couldnt get him to write a letter. I did get my medical records and gave them to the PS. They went through them and only found that I was treated for a rash or infection 3 times in the past year. I use an OTC anti fungal cream on a regular basis, wash often, and use an anti persperant and deoderant to keep my rashes at bay. If I dont do this religously I will keep a rash. Even with this it gets to a point sometimes, especially in the hot, humid summers we have here in the south that I cant control it. Thats when I go to my PCP. The PS and I wrote a letter and we resubmitted for an appeal this past Wed. This time the PS is not so optomistic. He now feels it isnt enough to show I have a real problem and that I will have to let myself get a rash and keep it for the better part of 3 months because that is the requirement from BCBS is 3 months of continually treament without being able to get it under control. I need anyone that believes in God to pray for me. The rashes are so painful. I have a pretty physical job and it hurts so bad to move and walk when I have a rash. I cant imagine keeping it for a full 3 months. When I do lose control of it and get a bad ra**** takes 2 to 4 weeks to get back under control. It is complete misery. I dont know if I could handle 3 months. It is almost the worst time of the year for me anyway. We have had a few days of 80 degree weather and I have been working outside in the yard. I have already had the beginning stages of a rash. I do not want to have a full blown case. I called the PS to see if he wanted to take a picture of it because it was very red on my stomach and also my upper thigh. But they said if it was still there next week to call them and come by. Well if I let it go till next week it will get full blown and take a month to get rid of. Can you believe that with a 10 inch overhang of belly down my leg that BCBS says that there is no evidence that I have any medical problems from it. You dont have to be in the medical field to KNOW that it would cause not only rashes and infections but back pain, numbness in my thighs, and cause balance and range of motion problems. Please pray, pray, pray I dont have to go through 3 months of misery to get approved this time. Anyone else on here have a panni that was as big as mine? If so what type of PS surgery did you have and are you satisfied with the results. I want an anchor cut because I also have a 2 cnd panni a little below my waist that is about the size of neck roll (pillow) and is larger than that on the right side of my stomach. The PS doesnt want to do an anchor cut because he does not like the way they heal. He doesnt want to do lipo on it either. HE wants to wait a year and let me come back for lipo. I will never have the money out of pocket for any proccedure that isnt coverd by insurance. I have read on here that several people have had the anchore cut and done well and are happy with it. Anyway sorry so long. I just needed to talk to people who might can understand. Thanks for listening. 

Even if insurance covers the panni, I have not heard of any approving the anchor cut. Go to a residency program and see what that would cost you. You may need to start researching plan b. Many of us here have paid out of pocket. Where there is a will, there is a way. Make sure your credit report is good and start looking into getting a loan as you continue to fight your insurance company. Good luck.

The Weight Loss Surgery Association of America offers an annual grant for plastic surgery, which you may wish to apply for. Good luck!!!

The insurance will most likely only cover a panniculectomy. Some PS will let you pay the extra and get a tt. You will have to show 3 months of continuous treatment by a physician for skin issues from the area. Generally, this falls within the time frame for filing the appeal. You will need to stop treating any rashes or infections or boils and go to the Dr. Also, take pictures of any and all rashes and print those in color. If you have any open sores ask the physician to culture it. The bottom line is the insurance has certain requirements and you have to meet them. Find a Dr take your ps letter and you denial letter when u go to the first exam. Explain that you will need him to document very detailed about your skin issues. Then if he/she is on board go for it. Then get copies of the physicians notes from each Dr visit as well as a referral letter.

As far as the severity and pain, just don't let them get full blown. I understand what you're dealing with and the frustration. I will be praying for you, but please be prepared to meet those requirements. I have BC BS and had the same issues and size too. I am 10 days post op panniculectomy. I have been going around and around with insurance since last September.

Thanks so much. I try to tell myself that every thing that happens is for a reason. I may not know but, God does and if this doesnt happen in my time, then it wasnt the right time. That God knows the perfect time and place. That is the truth but sometimes even if you know the truth it is hard to find peace with it when its not the way you want. Thank you again!!! Be Blessed!!! I pray a rapid healing for you!!