Question:
Is it hard to get approved by insurance

I have lost 100 lbs. I am 11 months post op. I have skin that is really sagging in the back area and hips. I just want to know from people that have had a body lift if it is hard to get approved for this surgery. I have anthem insurance. Do the insurance companies look down on this type of surgery and what do you need to have your dr. or what do you need to do to try to convince them that you really need this surgery to remove excess skin? thank you for any help    — taterbug898 (posted on November 6, 2005)

November 6, 2005
I just wanted to say congratulations on you WL. I am not sure about anthem paying for the cosmetic surgery. I would say got to www.anthem.com, I tried to find the link directly to the site, but its down this time of night. Also, please let me know if you find out any thing. Melissa Smith [email protected]
   — kizie23

November 6, 2005
Melinda, Insurances will most likely cover the tummy tuck part of the skin removal but usually no more than that. The rest has to come out of pocket. What they are looking for from your Dr. Is documentation proving that the extra belly skin is causing you medical problems in some way. It can be anything from the extra skin causing back problems to skin rashes, skin ulsers under the belly flap you name it. Plus having over a 100lbs weight loss. They need all of this proof to approve when you apply. If you have good insurance they will most likely cover the tummy tuck if not you may have to jump a few hoops to get them to approve. And some just wont no matter what. Hope this helps. Your WLS Sister Jo Michalko
   — Jo_Michalko

November 6, 2005
I agree with Melissa. The best place to get information is directly from your insurance company. either go to their website or call and ask! Many companies will not cover even a "tummy tuck, " which involves cutting the muscle, but will cover just a panniculectomy (sp?) which is just a removal of the loose skin of your stomach, if it has been causing ackache or rashes. I really do notunderstand why insurance companies do not cover loose skin removal all over the body, since the surgery lowers our risk of other health problems. There are other conditions that they pay for plastic surgery for!
   — Novashannon

November 7, 2005
i have anthem as well and only got the tummy tuck approved. i was hoping to have a thigh lift as well but no luck. if you find success in another answer please let me know too> [email protected] good luck
   — tjjjx6

November 7, 2005
Hi and good for you! Now you deserve to look great after all thta hard work. Most companies will base coverage on medical necessity, so careful documentation of medical problems related to excess skin should be done. "Teambuilding for success" is also very important. Most patients face out-of-pocket expenses because so much of what we plastic surgeons do (new belly button, muscle tightening, lipo-sculpting, etc) is not even listed as a procedure in the code book or considered "not covered" because its "cosmetic." Check PATIENT RESOURCES at drlomonaco.com where I have a downloadable document that may help. Also a newsletter article on Neweighweb.com that will be posted soon I hope. Hope this helps!
   — DrL