Question:
Are insurers req'd to pay for reconstructive surgery if they paid for your WLS?

I read at another site that there was legislation (can't recall if it was stated that it was pending or approved) that would require insurers who approved WLS to pay for reconstructive surgery to return the patient to a "normal" appearance. I don't recall whether the patient had to have rashes, etc. to qualify---just that the sagging skin to be removed etc. Folks, I need a sanity check! Any truth to this? Lucky    — Lucky B. (posted on January 21, 2004)

January 21, 2004
Wow that'd be nice, but I doubt it. I think it comes down to whether it is a medical necessity (ie, rash, boils, size of panni, etc.). I assume I'll qualify for a breast reduction but everything else I'd have to pay for.
   — mrsmyranow

January 21, 2004
No they do not have to pay. I have BCBS PPO and they denied my thigh lift, but did approve my tt. It depends on what your employer is paying out too, I know someone who has tried to get approved for the tt and was denied and hers is actually worse than mine, we have the same insurance, but our husbands work for different steel companies. It really sucks! I think they should cover it or at least half for RS, we are not going in just for big boobs lol although I need them too now. To complete the rest of my RS it's going to cost me a little over 12,000.00 and that's not including my breasts :o( Good luck!
   — Sandy M.

January 21, 2004
How I wish this was true. I've had 3 reconstructive surgeries and only got the insurance to pay for my tt. The rest I've paid for myself.
   — Patty H.

January 21, 2004
I WISH !!
   — charanewme

January 21, 2004
Unfortunately, insurers don't have to pay for reconstructive surgery after WLS. I work for a company that is self insured, and last year, two lovely people made sure to screw it up for everyone else with appeals for more surgeries after WLS that were more cosmetic than anything. In the end, the "plan" changed so that no surgeries - such as panniculectomies and abdominoplasties - are covered as a result of WLS! I hope to be able to work with a plastic surgeon who can help me get approval for an abdominoplasty for abdominal muscle tissue damage that was done before I had WLS. I seriously doubt that there will be legislation to "force" insurance companies to cover reconstructive or plastic surgeries after WLS, since there really aren't medically necessary (i.e., nothing life threatening will happen if you don't have the sagging skin removed.)
   — koogy

January 22, 2004
Wow. And I thought Santa Clause took January off. ;-)<P>This will never happen, and it never should. Medically necessary reconstructive surgery is one thing; cosmetic surgery is another. I imagine that line is wobbly, and not very well-drawn, from one insurance company to another (or even from patient to patient). And I don't mean to disparage anyone's desire for reconstructive surgery, post-WLS (at 140 pounds down myself, I'm sporting the melted candle look myself).<P>Still, I'm sure the cost of requiring insurance companies to provide reconstructive surgery for every person for whom WLS was approved, regardless of demonstrating particularized medical necessity, would be prohibitively high. If it were linked to the WLS approval decision, you can be sure WLS would be approved far less frequently. Moreover, would anyone want their plastics to come at the cost of somebody's else's medical care? 'Cause *somebody* would have to pay for this, for sure.
   — Suzy C.