Question:
Seeing my plastic surgeon this week and need expert advice

I am approx 14 months post and have lost 107#, my belly, legs, arms, and boobs are hanging. My PCP gave me a referral to see the surgeon for a TT because I'm having back pain and I'm going to say rashes, even though they haven't occurred. I saw one woman on here who got all her plastic surgeries approved at one time and I was wondering if anyone else had that happen, or how I should approach all the other surgeries that I would love to have. I realize that my ins. might say no way, but I'm looking for hints, tips, wording, things to do, not to do or say that will enable me to be accepted for some of these surgeries. I personally believe that losing 107# is justification enough, but then again I know the ins. co. might not agree. Thanks so much.    — patsy B. (posted on December 9, 2001)

December 8, 2001
To get insurance approval, a TT is not a TT, it is a panniculectomy. Yes, it gives you back pain, and you have a constant candida rash underneath it. This is controlled by 2 showers a day followed by lying on your back in bed, lifting up the pannus and using a blow dryer to dry underneath it. You may also have a "pins and needles" sensation down one leg or the other as the pannus pinches the femoral nerve where it crosses the pelvis. Don't even mention the way your clothes fit--the insurance co. considers that pure vanity. I'm passing this on because this is the way I got approved for a panniculectomy in 1999. I had a BPD/DS 10/01 and have lost 35 lbs. I'm looking forward to losing at least 100 more lbs and then having a mastopexy surgery--lifting and repositioning of the breasts.
   — dantevolta

December 10, 2001
I am 3 weeks post-op an abdominoplasty and bilateral (armlift) brachioplasty surgery. An abdominoplasty is a surgery that not only removes excess fat and skin, but tightens "loose" abdominal muscles. A panniculectomy only removes the excess fat and skin, but does not involve any muscle repair at all. My plastic surgeon always asks the insurance provider(s) for approval for abdominoplasty...then if it turns out that a panniculectomy is all that is needed, the provider is even happier because they have to pay less. My primary and secondary insurance providers paid for the surgery, although the primary denied initially and I had to go through an appeals process. When I appealed, I submitted letters of medical support from my plastic surgeon, bariatric surgeon and my PCP, as well as my own personal "testimonial" letter stating my desire and rationale for wanting this RECONSTRUCTIVE surgery. I also attached the 1996 Position Paper from the American Society of Plastic Surgeons, entitled "Treatment of Skin Redundancy Following Massive Weight Loss". A copy of this paper can be obtained from http://www.plasticsurgery.org/profinfo/pospap/skin.htm. My physicians stated chronic back and shoulder discomfort/pain, recurrent skin infections/rashes exacerbated by Type II diabetes, and loss of functional ability and mobility associated with excess redundant tissue as rationale for this "necessary reconstructive surgery". Some patients plead emotional and psychological trauma as a rationale, and although the excess, hanging skin is "cosmetically" devastating to one's self-image, it is generally true that most insurance providers are not sensitive to that issue. If your provider denies your request initially, I found that it is indeed worthwhile to go through the added time and effort to appeal. In fact, my plastic surgeon stated that it was fairly "routine" for providers to automatically deny a request the first time around, but to approve subsequent appeals. Thigh lifts are almost without exception viewed as "cosmetic" by insurance providers. Breast reduction/lifts are often covered, especially when supporting photographs are submitted to the provider. I found this surgery to be the most "comfortable" major surgery that I have ever had. After the first day, I would say that my pain was no worse than a bad paper cut, and easily controlled by Percocet tablets for pain. I have an "anchor" incision...a long vertical incision from breastbone to pubic bone, then a horizontal "smiley-face" incision from hipbone to hipbone. The incisions on my arms are from elbow to armpit. I had no external sutures or staples, except around my new belly-button, and I believe that these scars will hardly be noticeable in a few months. After surgery, my surgeon told me that I now had the abs and arms of a 16 year old. I quickly reframed that statement for him....I didn't have abs and arms this nice when I WAS 16!! I'm really happy that I made the decision to have the surgery. Good luck to you!
   — Diana T.