Anyone had Insurance that paid for TT/Hernia Repair??

Hi! I had RNY almost 6 years ago, and a revision 3 months ago. I'm doing good as I only have about 22.5 lbs to go to reach my goal!

Just this week I suddenly developed a big hernia in the middle of my abdomen, along the incision line from my surgery, above the belly button.

All together I've lost about 65 lbs......with lots of extra skin hanging. I get frequent infections under the skin rolls but usually treat them with OTC meds so there's not more than one or two mentions about these in my medical records.

I am hoping my insurance will pay for the skin removal to be done when my hernia is fixed.

My RNY surgeon wants to fix the hernia, and he said they might pay for a panniculectomy if I get more documentation of the skin infections onto my chart.

Here's the problem, he has only done "a couple" of panni's in his whole career! I know it's already not as good an option as a TT but don't know if I can get a loan for a TT......but that said, if I must get the panni done, I think I want it done as well as it can be done, you know?? By someone who is really good at them.

Have any of you been able to get insurance approval for a TT with hernia repair?? If so, what state are you in? Insurance?

I live in PA and have Freedom Blue Cross (a Medicare plan, I am on disability). The surgeons coordinator actually thought I would have trouble getting my revision approved, but they approved it in less than 24 hours from when it was submitted.

do you guys think I should get a second opinion from a plastic surgeon?

I don't want to offend my gastric surgeon, but this might be my ONLY opportunity to get my belly fixed! This is something I have dreamed of for over 30 years!

After my first pregnancy at age 19, my skin was so stretched (cause back then I was TINY lol), that it made the "pouch" and hung down, and it's only gotten worse with being obese for years and then losing the weight.

Financially though, it's extremely unlikely that I could get a TT - I doubt I could get the loan approved, seriously doubt.

Anyway, sorry this is so long, I just really need some advice! One more thing though (I promise!), is that since I finally got my deductible met, I want to get whichever surgery done before the end of the year......so not much time to ponder my decision! No pressure here lol!

Thanks for any stories, advice, links or anything at all you might have to help me figure this out!!

Roni :)

ps.....pay no attention to my counter thing, I need to update it! 😜

I am having a LBL(with fleur des lis incision and muscle tightening) BA/Arms done in December.  My surgeon said it is rare that plastics would be covered but once he saw me naked he thought I had a good shot at insurance covering it and recommended submitting pictures.  It was determined that my insurance, BCBSTX, will cover the panniculetomy as long as it was coded as a skin excision.  This means that insurance will now cover the overnight stay in the hospital, the anesthesia, one binder garment etc.  My original price was $30,000 and  with insurance kicking in I should save around $3,000.  Not much but every bit helps.

If you submit to insurance and are denied I would ask for a peer review(not sure the technical term) where your doctor has a phone consult with the insurance doctor.  I hear that often helps.  Good luck!!

Good idea.....thanks!

I had to laugh to myself when you mentioned pictures! I keep telling my friend that in order for me to raise plastic surgery money on GoFundMe.com, I'm going to post pictures of myself in a bikini - and refuse to take them down until I get the money I need lol! People would be so disturbed by THAT sight that they would gladly pay me just to get rid of the pictures! Haha! 😜

Thanks again for the ideas!

Roni :)

I would think that repairing the hernia would be no issue with insurance coverage - I had to have that done.  I wanted to have my bariatric scar revised because I had open surgery.  So, I was already dealing with a plastic surgeon who was also a board certified general surgeon so he did the hernia repair.  Since I was lucky enough that the hernia was located at the bariatric incision so I got the scar revision covered by insurance.  As far as the TT, if you are dealing with a plastic surgeon, he can submit to insurance to see if they will cover anything and if not, let you know the difference in price from what insurance would pay - hopefully not that much more.  As far as who should do the TT, I would not let anyone other than a plastics guy with experience do this.  I see lots of complaints of people not happy and that is even with a plastics person doing the work.  I wouldn't want to be a test subject for anyone.  Good luck in your journey.

That's almost my exact situation! My hernia is right in the middle of my open RNY/RNY Revision incision! They did both surgeries along the same huge incision.

I would definitely get a second opinion from a plastic surgeon that specializes in post-bariatric face and body contouring. I would be a little concerned if your doctor says that he has only done a few of them. Also, a TT should be much more beneficial to you than panniculectomy. You may want to ask your plastic surgeon about discounted surgery for media appearances. I just had another one that I include here:

We do get media inquiries for patients that want to share their stories. I just received one regarding a TV show that is going to be produced. This is from talent scout for show:

"I am reaching out to you to help find these fascinating stories, as we'd love to  follow one of your patients. The patient will be financially compensated for appearing on the show. If your patients, are interested in appearing on the show all I need to do at this stage is pre-interview them to hear their story."

If anyone is interested in this opportunity, please contact Rachelle at ([email protected]). It would be helpful to include at least one photograph. Dr.Domanskis

Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery 1441 Avocado Avenue, Suite 307 Newport Beach, California 92660 949.640-6324/1.888.234-5080(Ca) Website: http://www.surgery-plastic.com Assistant Clinical Professor of SurgeryWOS-Plastic,University of California (Irvine) Orange County’s Physician of Excellence/America’s Top Physicians/Top Doctors Plastic Surgery- 2005/2006/2007/2008/2009/2012/2013 President,American Society of Bariatric Plastic Surgeons www.ASBPS.org

Non-Toxic, No Nanos Skin Care- www.ORGANODERM.com

Scar Therapy-www.ScaRxtape.com