Question:
Will Insurance Pay for Post-Op Plastic Surgery

I read the article in People that stated Carnie Wilson's insurance did NOT pay for her post-op plastic surgery. This really concerns me as I don't have $20K to plop down. Have any of you post-op's been able to get this covered by your insurance carriers? Thanks, Lora    — LoraMullen (posted on June 20, 2002)

June 20, 2002
from what i have seen alot of insurances will pay for the panni-ectomy (for lack of the proper name) which is the removal of the excess skin on the stomach because it can cause hernias, back pain, lack of mobility... but the others are out of pocket from what ive seen.. I did see one woman get her thighs and back covered (trunkoplasty or something) but it took almost a year of appeals with the insurance co and she started at over 500lbs and ended up at like 150 or something and the excess skin kept getting infected ... so there were other medical reasons to appeal as well...
   — Mary G.

June 20, 2002
Hi there Lora. I hope this is somewhat helpful to you...if not; forgive me! I'm 9 months post-op and I've lost 177 lbs. At 7 months post-op I was down 154 and I went to see a plastic surgeon. I supplied my plastic surgeon with pictures of my rashes (one under the "mid drift" and one in the "subpubic" area). I had my dermatologist fax a letter to the plastic surgeon's office; I made copies of my 2 seperate RX's (creams) and my plastic surgeon included pictures that he took of me in the office. Well, it took a while for the dermatologist to dictate the letter---but when she got it to the plastic surgeon, they faxed it in. Almost 2 weeks ago I got my denial letter from Cigna HMO of FL. I don't have my denial letter on me, but here's what it said...basically. It said that the abdomenoplasty (sp?) was not covered because it was considered cosmetic. It was considered cosmetic because there was no proof that I was counseled on proper hyegine and that the creams failed, which I was, and they did...but I haven't been in for a follow up yet. If I could prove this, then they would consider it reconstructive--which is covered (but does that mean they WILL cover it...I don't know! :o) Now, I should tell you that I was informed that my arm lift would not be covered---so I am saving up the almost $3000 for that. But, right now I'm in the process of documenting my stomach rashes, any prescriptions, making appts. with my dermatologist and PCP~ all in order to prove that these creams are not working. I also have made it clear to all the Dr's that I see about this problem, that this is for ins. approval purposes for an abdomenoplasty. So, my suggestion to you would be to document with photos and a notebook log (dates, how long they last, what RX's were prescribed---their effects, if any) and start meeting with plastic surgeons as you get closer to the time you would desire such a procedure. Keep RX reciepts...keep photos, make sure that the DR's you see are willing to dictate letters documenting your problems...and then beyond that, PRAY! I don't have 20G's to plop down for the surgeries either---but you can still do your homework and hopefully get desirable results! Good Luck!
   — Kristin R.

June 20, 2002
Mine did - (extended Abdominoplasty - included panniculectomy). My PS took pictures of me, submitted letter of Medical Necessity (the panniculus seriously affected the "quality of my life") and it was approved within days.
   — Cathy J.

June 20, 2002
I had a panniculectomy and armlift done in November. My plastic surgeon submitted frontal and profile photographs along with his letter of medical necessity to both primary and secondary insurance providers. My secondary insurance (Acordia) approved the surgery (including the armlift) immediately, with no questions asked. The primary denied the surgery forcing me into their appeals process. Since they already had the photographs, I assembled a packet for the appeal which included a copy of the plastic surgeon's original letter, letters of support from my PCP and bariatric surgeon, a personal letter which outlined in detail all the reasons that this RECONSTRUCTIVE (never use the word "cosmetic") surgery was important to me, and a copy of the 1996 Position Paper from the American Society of Plastic Surgeons entitled "Treatment of Skin Redundancy Following Massive Weight Loss". My primary provider (CIGNA PPO) approved both the panniculectomy and armlift surgery within two weeks of the appeal. I wish you the same good luck!
   — Diana T.

June 20, 2002
I just got approved this week for an abdominoplasty. I started out as a "lightweight" but have lost almost 100 pounds. The insurance company originally denied the abdominoplasty until they received the pictures. That's what caused the approval of the procedure. One thing I can tell you about the pictures, from the front and side views, it looked like I had a problem, but not a severe one. However, my doctor made me turn to the side, grab ahold of my stomach and pull it out as far as I could and that CLEARLY showed how much excess skin I had. THAT picture I believe got me the approval.
   — Patty H.

June 20, 2002
As the others have said, the key is "medical necessity." Medical necessity is deemed "reconstructive", NOT cosmetic.
   — Leslie F.

June 20, 2002
I was approved for abdominoplasty and thigh lift after an appeal. I will tell you what I included to get approved. I had a letter from my PCP documenting treatment for rashes and back pain. I had a letter documenting the same complaints from my RNY surgeon (just make sure he makes those notes when you see him for follow up visits), I had a letter from my psychiatrist that this excess skin was causing me pain, rashes, some sexual disfunction, and depression. I had a letter from the plastic surgeon and pictures. You will need to take pictures every time you have a rash if possible. I would suggest that people start building this portfolio of proof as soon as you have lost even 30 or 40 pounds. By the way, I had surgery Oct.17, 2001 and started out at 265, I am down to 162. I am having surgery July 1, and of course, I am a little nervous.
   — cindy Q.

June 25, 2002
Thanks everyone for all the great answers. I haven't even had surgery yet but I am trying to learn EVERYTHING I can before. Thank you, thank you, thank you! Lora
   — LoraMullen