Plastics Insurance experience?

NatalieNTexas
on 3/25/14 8:55 pm - houston, TX

Hello!  I am curious if anyone has any experience getting approved for body contouring through insurance. I paid cash for my surgery back in 2007 and the amount of excess skin I have is ridiculous and uncomfortable to say the least.  Granted..I do not have boils bursting out of every fold ..I do have issues that i am now realizing that maybe I should start documenting.  If anyone is willing to share can you tell me what your insurance providers requirements were, what type of insurance, your pre op BMI and anything else you think that might be helpful. My case is going to be weird because I paid cash originally in the first place. Any advice would be greatly appreciated. 

 

Thanks!

JazzyOne9254
on 3/26/14 6:50 am

I am in the midst of finishing up medically necessary excess thigh skin excision. 

The key is getting the surgeon to use the  codesin such a way to suggest excision is resolving a  medical condition, not codes that would indicate appearance improvement only.

My excess skin interfered with walking unless it was stuffed into a very snug pants liner, which often led to chafing  and cellulitis infections from germs getting into the broken skin.  I have had to use four different antibiotics on various occasions for the repeated infections, because the germ grew resistant to the previous one.

Both my PCP and my dermatologist wrote letters to my insurance company detailing the severity of my problem.

I was going to get the all at once thigh reduction surgery (not a spiral thigh lift), but once I was in the operating room, the surgeon decided to stage it, because of the amount of skin I would lose all at one time.

You also need to document each time you get an infection, what kind it was (sometimes they have to do a culture to find the antibiotic the germ is vulnerable to, especially if it's MRSA), what the treatment was, how much the treatment cost, Rx or OTC medicine used, how long it took to heal, healing complications if any.

You can make up a chart, or buy one of those composition books and write it out as you would a journal or diary.

That's pretty much what I did.  Insurance approved for the entire lower body, hips, thighs and lower legs. Many have a tummy tuck with the lower body work, but I didn't need one.

HW 405/SW 397/CW 138/GW 160  Do the research!  Check the stats!
The DS is *THE* solution to Severe Morbid Obesity!

    

Kim S.
on 3/27/14 12:57 am - Helena, AL

My insurance provides coverage for excess skin removal after massive weight loss.  HOWEVER, the skin MUST be causing medical issues, such as infections or limited movement.  I had a fair amount of excess skin, but never had an infection, and it did not affect my movement in any way.  My PS said "no way" insurance will cover a dime.  So I wrote a big fat check for my LBL and BL.  Best money I ever spent. 

I never felt ashamed of my skin, nor did it slow me down.  I honestly never considered plastics.  However, I live in the deep South, and the summer heat is brutal.  I was having to shower twice a day and change clothes often due to the sweating from the skin on skin.  Add to that the fact that every time I ran I had my own traveling applause, and I just decided enough was enough.  I opted for the LBL because I really had MORE skin on the back than the front, and had issues with pants fitting properly. My sister talked me into the BL because she said I'd be CRAZY to do the lower half and still have "rock in sock" boobs.  She was right-I'm glad I did it all. I have no further plans for additional PS.  Except my face- I reserve the right to get a face lift one day if I need and want it!!

             
     
(deactivated member)
on 3/31/14 2:16 am

I agree with the posts. Insurance carriers are very fickle and it is best to present it as helping take care of a medical problem, like dermatitis, difficulty walking. Unfortunately, at this time, just having excess skin is very rarely covered though the American Society of Bariatric Plastic Surgeons is working on changing this.

×