Help!! PS & Insurance (Long)

Please help!! 18 months out and never “at goal” but all drs are happy; I was a Lightweight,  and I’m stable for 9 months at a good weight, size 12 petite, etc.  Lots of hanging skin, pannus, pubus, , facial, actually everywhere but looking for TT.

Problem:  job didn’t work out (BCBS), on husband’s insurance (Aetna HMO), and waiting for new job’s insurance in August  (United Healthcare Choice Plus).

 Went to PS and applied for insurance with pix and med history of rashes, discomfort,etc. and was denied (not surprised since they are denying more and more but still hopeful) for “Not medical necessity, need to have lost 100 lbs and I only have at 80,  pannus must hang over pubus and doesn’t in pix, and not enough rashes.

Question is I paid for cobra to apply and can apply for coverage on other 2 insurances although I had more faith in the BCBS system but cobra is $450/mo.

What is your history? Should I invest in cobra for an appeal or just go to the next insurance company.  I must admit I’m worried since I had almost 3 years of insurance companies and submissions to have the WLS. I really can’t afford to keep paying for cobra if I’m just going to make myself crazy and not have this covered anyway. 

Please help with advice, histories, etc.  I’m very confused and all the job changes and insurance complexities don’t help.  Should I just let the BCBS go and keep going?  Is BCBS the best outlet? What experiences are out there?

Congratulations on your weight loss success and keep up with the solid and regular documentation of the rashes. Other contributing factors might be chronic back and shoulder aches and joint pain from carrying around a grade 2 or more pannus and or laboring under excessively large weighty breasts.

Can't advise on your specific insurance plans or cobra, but I can advise to stop using the words "plastic surgery." So stop that, girl! **Smiling** To my knowledge, insurance companies never cover plastic surgery. What they "sometimes" will cover are "reconstructive surgeries" when deemed medically necessary." I suggest you get "detailed  copies, often found online of each and every applicable insurance plan and seek out their specific requirements and or exclusions. Have you appealed? Insurance companies routinely deny reconstructive procedures even when medically necessary. Appealing those denials up the ladder is often required for success. You might check out the plastic surgey board here on OH for those you have successfully won their appeals. Good luck! Rock ------------- Never agree to plastic surgery if the doctor's office is full of Picasso's portraits. ;-) ~ Anonymous

Hi Carol, I had a LBL almost 5 weeks ago.  I have Aetna HMO insurance and the PS did refer to the surgery as " reconstructive" !!!   That is what you need to call it NOT plastic surgery.  LOL   You can call it PS to us though.  I did meet all of my insurance co. requirements for them to pay but they still denied coverage.   You can go on my profile if you would like and see how HUGE my pannus was before surgery and what it looks like now.    I did have to pay 100% of the LBL myself.   I don't regret one cent that I spent though.   I finally feel like a normal person.   LOL   Isn't it funny what we base being "normal" as ???   LOL    Mine was not to have the hanging skin on my stomach and abs.    I do have hanging skin in other places but that doesn't bother me at all....just that huge pannus hanging was the pitts.   I wish you lots of luck on your journey to get your surgery paid.   I would just weight out the payment that you are making each month and the actual cost of the procedure and see if you think that it is worth it to pay out the premiums.    My LBL complete with everything cost me $10,960. Hugs and blessings ~~~ Vivian