Question:
ANY WAY to get insurance to pay for the arm surgery?

I have back pain, neck pain, shoulder pain, migraines, infections under the boobage and between legs, and rashes. I want to get a breast reduction because they're MASSIVE, and a tummy tuck, belt lipectomy, and the brachioplasty. Do you think any of the PPO insurance co's would pay for that if I harassed and harassed and harassed? I have lost 140 lbs and have 80 to go. I'm wondering if I also want the bypass again, or the lapband. :/    — MarsRenee (posted on February 14, 2008)

February 14, 2008
Yes, there is a chance that you can get insurance to pay for certain plastic surgeries. You say you are wondering if you want a revision of your RNY or to add a lapband?? Have you researched the Duodenal Switch?
   — SameButDifferent

February 14, 2008
Yes, it sounds like you have a good chance of getting them to pay. My mother in laws Dr. helped her to get her plastic surgery paid for. Good luck to you!!!
   — Carlyn M.

February 14, 2008
how long ago did u have your first surgery? how much do u weigh now? They say on here that DR's won't do it again, that if we failed the first time, why would they do it again, i think failure is not the right word, we are all human and there is a weakness within us that has put us in this position to start with. I wish i had had mine down sooner, i am 59 , Gosh i missed so many years with my kids that i would have felt good and healthy, but no use to worry about it now, i love the way i feel , so much healthier and happier... I do need some plastic surgery, but i can't afford it and insurance won't cover it... I could go to Mexico and have a full body lift for 16.000 not counting air fair and some hotel fees... i wish i could win the lottery...i would spend it all on ME !!
   — Reelbaby

February 14, 2008
Sounds to me like they should. I had United Health Care, PPO and had a tummy tuck and male breast reduction and had no problem with the insurance company. Having it all done was one of the best things I could ever do! Best of luck, plz keep us posted.
   — Jason B.

February 14, 2008
With all the pain you are having and with the right physician to write up the information for the insurance company as a medical necessity -- I don't see why not.
   — the7thdean

February 14, 2008
I lost 140 lbs. So I didn't fail. What is the Duodenal Switch?
   — MarsRenee

February 14, 2008
/insurance will cover it if medically necessary but you want to lose all your weight and show you maintain. Also have you had surgery already if not look into that first. But if you have had the by pass why would you want to do it again? It is a tool that you can use if you apply it.
   — tl_morgan

February 17, 2008
The insurance company would most likely pay for some but not all of the plastic surgery. Make sure your doctor thoroughly documents all of your complaints at each visit. And you might want to make a point of going to the doctor when you are having any type of flare of these symptoms... It might also be helpful to document, with photos, (and encourage your doctor to do the same) these complaints. Generally, one of the requirements for this type of surgery, by both the insurance company and surgeon, is that you are at or near your goal weight (or that you have lost as much as you are realistically going to lose) and that your weight has been stable for some period of time. If you had surgery and lost another 80lbs, you'd end up with more loose skin and probably need/want to have a second surgery... this adds more risk, is more complicated due to scar tissue, and costs more $$$$$. As far as wanting more WLS surgery, my understanding is that once you are bypassed, you are bypassed. Unless you have some kind of anatomical breakdown, they can't re-bypass your stomach... lap band might be an option though. Harassment isn't going to make an insurance company approve a claim... they either cover it or they don't. If they cover it, find out the requirements, do what you need to document it, and get your doctor to help advocate for you. Calling to check on the status of your claim might be helpful... while they can't use harassment as a reason to deny a claim, they could use it as a sign of mental instability and require counseling and/or psych evaluations before approving surgery. Good luck to you... congrats on the 140lbs!
   — mrsidknee