Question:
Could I possibly have a chance?

I'm 23 years old, 326lbs - still have about 3 weeks until my LAP RNY, but I have a question about possible reconstructive surgery. This is coming directly from the Exclusions section of my contract: 10. Cosmetic Surgery. No benefits are provided for any services in connection with elective cosmetic surgery or any hospitalization in connection with such surgery. However, benefits are available for reconstructive surgery if it is incidental to or follows surgery resulting from trauma, an infection or other diseases of the involved part. I know that it's WAAAYYY early for me to even have to deal with this but it will most definitely be a bridge I'll have to cross (panniculectomy or abdominoplasty). What trauma are they talking about? Hernias and/or those lovely rashes? Or would it be something geared towards trauma as a result of an accident, fire, etc.? Thanks for your help! :)    — Tamisia (posted on March 13, 2004)

March 13, 2004
It's my opinion that trauma in this instance is referring to something causing a disfiguration. But what you might concentrate on is what follows the word trauma in the sentence you quoted. Specifically, I mean where it talks about diseases of the involved part. I think THAT'S where you might be able to interpret this to mean hernias or rashes (of the involved part). Good luck!!
   — Deborah L.

March 13, 2004
I think there is always the opportunity to go for it. A well written, thought out letter of request can always be considered. I would focus on the reconstructive aspect. The loss of a lot of weight can lead to changes in your posture and susbsequent back pain - but you will have to wait and see. Also, you are young enough that your skin may have enough elasticity that you may not need plastic surgery! All the best on your journey!
   — koogy

March 14, 2004
I'm in the same boat hon. I'm down 167 and 7 mo. post op. I knew going in that the chances were sketchy of getting approved for cosmetic surgery, but I'm hopeful, and I think you should be too. My insurance states about the same. My surgeons told me, however, that approval for plastic surgery can often be aided by a few things. First of all, it may indeed be considered a follow-up surgery to your wls if your skin situation is bad enough. Your morbid obesity can be considered a disease, and the wls the surgery that results in the need for a panni or tt. You might just need to be really loud and obnoxious about it with the ins. company! Document rashes, boils, back pains, anything else that can be contributed to carrying around that extra skin. Go to the doctor with a bad zit if you have to! Also, if you develop a hernia post op, which some people do, it may be easier. They'll have to go in and operate again anyway. (Not that I'd wish that on anybody, but if it happens, it's not the end of the world, and might just work out in your favor.) And of course, we always hope we won 't need plastic surgery at all :) You're on the right track, trying to get all your ducks in a row! Just keep on top of it so that if and when you need ps, you'll have a strong case and documentation in your favor! Worst case scenario, you need PS and it isn't covered. You have to skip it or pay for it out of pocket. Whatever the case, this surgery is still a godsend and you're going to feel fantastic. Flappy skin or not:) Good luck! :)
   — christied

March 15, 2004
Why don't you call the number on your insurance card and ask them if it is covered? I believe the trauma they are talking about is from something in the form of an accident, but talk to them and see if it's covered. Many times this is an out of pocket expense and if it is start saving. When you go to your doctor have him/her document any rashes and get some medication for it. By the time you are ready for surgery, you'll already have a documented history. Good luck and pick up that phone.
   — Diane B.