Question:
Plastic Surgery- Have hernia, no rashes.. idea on approval?

Hernia? yes. Rash? no. Covered TT? OK I do have the hernia but I don't have any rashes under the extra skin. Any ideas on if I will be approved for reconstructive surgery to remove the hanging skin? I want it all, the boob, tummy, hip, thigh, and arm lifts. What should my chief (other than my friend, Hermie) complaint be, when I see a PS?    — jocelyn (posted on July 12, 2003)

July 12, 2003
I have had mild to severe back and shoulder pain since losing 95 pounds--I am trying to get the skin removal(note I didn't say TT) covered. Right now I have a verbal approval and waiting for the letter. I went thru my PCP to refered me to a back doctor, who then refered me to a plastic surgeon.
   — barbara A.

July 13, 2003
You are very lucky not to have a rash. I am sure other conditions can help you to get approved for TT as well, such as: shoulder back pain, your hernia alone will help you to be approved, but mostly the amount of hanging skin you have. What kind of insurance? That is the most important thing from what I understand. I am in the process too and I have BC/BS federal and as secondary BC/BS of Illinois. Anyone have any success with these two insuraces? Although I have been documenting rashes for the past year with my pcp and a dermatologist, I remember reading that someone on here got a terrible rash from spraying hair spray in the apron area????? Don't know if this was intentional or an accident but that is what I read. I don't think it would be wise to do this intentionally because these rashes are very uncomfortable and painful too. Good luck getting approved! Never give up trying.
   — Mylou52

July 13, 2003
Hi, My insurance BCBS HMO Blue will allow a TT not only due to rashes, but if it affects you mobility, causes pain....I am sure you can come up with some problems as a result of the skin...oops did I say that.......
   — Kriola

July 13, 2003
I don't know about all insurance companies, but a hernia is not an instant reason to get approval for a tummy tuck/abdominoplasty. The hernia can be repaired (either laparoscopically or open) WITHOUT any tuck. The tuck will make the area look better but the hernia repair does not in any way alter the area or necessitate reconstruction. I recently had an open hernia repair/full abdominoplasty. I had to get the procedure done this summer because I go back to school in September. So, I didn't even try to go through an appeal. I applied for a tummy tuck/breast reduction at one year post-op and was immediately denied. My PS said there was NO WAY my insurance (GHI) would approve of a tummy tuck in my case. My tummy did not even go over my pubis. I had extra skin but it really wasn't apparent when standing. So, I didn't even apply for approval (my PS would not even apply). I was initially quite upset about this but upon meeting others, I knew that approval was not something that I could expect. I'm not sure if I would have been able to finally get approval with appeals, etc. Somehow I think not because my belly really, really, really wasn't that large. I never even thought I'd get any plastic surgery done because my skin wasn't that excessive. So, the hernia gave me an opportunity get the tummy fixed! I paid a surgeon's fee (5K - this is pretty common for NYC and Dr. Karp is one of the Top 200 surgeons) and will part part of the OR time and anesthesia. A tummy tuck alone would cost about 15k, so having the hernia repaired along with it (this was approved and hospital stay included) really reduced the cost considerably. I think if you have an extensive pannus, have documented problems, fight, fight, fight! But, really, if your pannus is not extensive - I don't see how you will get covered. You'll have to decide whether you think it's worth it to pay some out of pocket (much less than if you did it alone). I am very glad I did it... only 5 days post-op and feeling tight, tight, tight! I'm overjoyed that I was able to get this tuck... I never thought I'd be able to afford it and it wasn't bad enough that I really, really needed it. I wish it were much easier for those post-ops who really need reconstruction to get their bodies back! I am grateful that my skin really bounced back and I don't 'need' any PS.. but the flip side of that is if you do want to get something done, there's a chance in hell that you'll get any reimbursement for it! I wanted to tighten my stomach muscles. They were totally shot. That was my first reason to get an abdominoplasty. The second was to remove the bulge I had on my tummy. I also HAD to get rid of the incrasingly HUGE incisional hernia that was growing like an alien above my belly button! All the best to everyone, (preop: 307 lbs/bmi 43 now: 160ish/bmi 23ish/ 5'10")
   — Teresa N.

July 13, 2003
The hernia is a start from my understanding. Anthem should pay for it, even if no rash. Are you having back problems? That could be from the need for a breast lift. The arms are a little harder to have done, but i'm sure if you sent in pics showing the amount of hanging skin, that would make it easier - Actually pics included in any reconstructive surgery is to your advantage especially if the problem is severe. I also plan to document throughly any problems I have with excess skin (which I'm sure will be fairly severe, unfortunately) Good luck and much success!! Robin
   — Robin J.