Plastics - State Employees

Gabrielle
on 11/30/08 10:58 pm - Chester, VA

Hello all,

I am 3 1/2 years post op RNY and starting to seriously consider plastic surgery. I am a state employee and I understand that others have had tummy tucks covered, and that thigh surgery has also been approved.

I would love to hear from anyone who has Anthem CoVA Care - what was your experience with getting plastics approved?

Also, if anyone has a recommendation of a plastic surgeon in Richmond who has lots of experience with folks like us, please let me know.

Thanks
Gabrielle

Tam
on 11/30/08 10:59 pm - Richmond, VA

RNY on 04/25/05

Plastics for COVA are covered if medically necessary. As for a surgeon...travel to NoVA and see Dr. Krieger. If you REALLY want to stay in Richmond then I recommend Dr. Zinsner. Good luck!

Tammy C

down 260+ pounds and loving life more than ever!!!
proud mom to Kara 12-08-1994 and our newest addition Claire Makenna born 03-26-09 weighing 6 lbs 13 ounces and 19.25 inches long and very healthy. happily dating...i honestly never knew it could be this good! there is that special Guy for everyone out there...either you already have him or you will find him when He is ready for it!

open RNY 04-25-2005

Life could not get any better than this!

Gabrielle
on 11/30/08 11:40 pm - Chester, VA

RNY on 07/14/05

Thanks for the recommendations!

What I've heard so far about CoVA is that for the panni, if it hangs over your pubic area it is covered. Just wondering what they require for the thighs.

Tam
on 11/30/08 11:43 pm - Richmond, VA

RNY on 04/25/05

I work for an ins company...ALL plastics are based on medical necessity unless you work for a company that covers them...and they are few and far in between. There is no guideline for coverage...just when the dr. submits they look at all the data and records and make a decesion.

Tammy C

down 260+ pounds and loving life more than ever!!!
proud mom to Kara 12-08-1994 and our newest addition Claire Makenna born 03-26-09 weighing 6 lbs 13 ounces and 19.25 inches long and very healthy. happily dating...i honestly never knew it could be this good! there is that special Guy for everyone out there...either you already have him or you will find him when He is ready for it!

open RNY 04-25-2005

Life could not get any better than this!

Gabrielle
on 12/1/08 5:00 am - Chester, VA

RNY on 07/14/05

Wow, that seems really subjective. I thought they had to have guidelines for decisions - a definition of what is considered medically necessary. Oh well. Thanks for the info!

Tam
on 12/1/08 5:05 am - Richmond, VA

RNY on 04/25/05

There are guidelines but each group is different on how detailed they want to be before they give approval. CoVA and FEP are the easiest to get approval for! Tighs are EXTREMELY hard to get approval for. Chances are slim to none they will be approved. TT is more available but also hard to get approval for. Documentation is key and having good photos and a good PS that is willing to fight and appeal for you.

Tammy C

down 260+ pounds and loving life more than ever!!!
proud mom to Kara 12-08-1994 and our newest addition Claire Makenna born 03-26-09 weighing 6 lbs 13 ounces and 19.25 inches long and very healthy. happily dating...i honestly never knew it could be this good! there is that special Guy for everyone out there...either you already have him or you will find him when He is ready for it!

open RNY 04-25-2005

Life could not get any better than this!

Shanana
on 12/1/08 3:51 am - Altavista, VA

RNY on 11/09/05

I have COVA care and tried for tummy tuck over a year ago. I had the rashes and such but still was denied. If you get approval, please let me know. I didnt have the panni so that may make a difference.
Shannon

The greatest of faults, I should say, is to be conscious of none. Thomas Carlyle
http://www.obesityhelp.com/forums/fibromyalgia/

Gabrielle
on 12/1/08 5:02 am - Chester, VA

RNY on 07/14/05

I am sorry to hear you were denied. If I get approved, I will certainly post. I do have the hanging panni so hopefully they will consider that. It sounds like there may be no real set guidelines, so who knows!

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Plastics - State Employees