Question:
How is NGS coverage for abdominoplasty/panni ?

I am wondering if anyone has had any experience with getting approval for an abdominoplasty/panni? Was it hard to get coverage for reconstructive surgery? Do they require alot of documentation? I'd appreciate any info!    — DeeAnn (posted on September 30, 2004)

September 30, 2004
I am currently trying to get insurance approval. I work for Mayo Clinic, they self-insur. I have been denied twice. I just sent in my request for a level 2 appeal. The criteria that Mayo's insurance has set up are so ridiculous that no one is likely to ever meet them. Rather than say they won't cover the surgery, they've made the criteria unreachable. I did have a Mayo Clinic plastic surgeon put in the request. He has told them that he feels this surgery is medically necessary but they are still not approving.
   — Kelly H.

September 30, 2004
Skin removal is considered cosmetic not reconstructive surgery by the insurance companies. Your doctors (primary and surgeon) need to be documenting that you are having physical problems because of the extra skin. Also, insurance companys require you to be post op for at least (min.) 1 yr to 18 months and be at a stable weight for 4 to 6 months before they even consider you for surgery. You should be at your goal and hold that goal for at least 4 to 6 months. If you are still losing they don't want to have to do the surgery again. Also, expect to pay some out of pocket monies. I have a surgery date for Dec 10th (butt, thigh and arm lift). Insurance is covering a basic butt and thigh but I need more extensive so that is going to cost me 4,000 and my arms are not covered so tha is 2,500. Grand total out of pocket 6,500. Most PS require that you pay that money upfront before the surgery. Some work with a financial company so you can take out a loan. The doctors that do the BY Pass surgery need to start explaining that SKIN REMOVAL may not be covered by insurance so you need to plan accordingly. I was willing to live with my excess skin but I was having problems sitting do to the extra skin. I can sit for more that 1/2 because of the pain. I wish you luck. In the meantime keep exercising. This way when you do have your surgery you will have more toned muscle and they won't have to do as much skin removal. EXERCISE is very important. It will not make all the excess skin go away but it will help you in the long run. Again, Good Luck. I hope you are approved.
   — Linda R.

September 30, 2004
I got to goal within 7 months or so and had pannilectomy w hernia repair less than 8 mths from my wls date,I weighed 133 pds going in.Not all doctors require you to wait a year if your very close to goal and have hernia or other documented problems.Also my weight was not stable for six months I lost ten pds the month before and after my plastic surgery.Both my weight loss surgeon and plastic surgeon recommended surgery .I lost a total of nine pds since my tt and seem to be leveling off at 122 pds.I advise you to seek individual consult based on your personalized needs.Good luck!
   — glori74