Question:
How do you get your insurance to cover a Panniculectomy or other?

I have been told that insurance doesn't cover this at all, but I see many of you have had insurance cover it occationally... How do you know if it is something you can apply for, and what are the qualifications to have this done? I don't want an apron, but it looks as though it will have to stay that way (don't have the $$$ to pay on my own)    — Marni R. (posted on January 16, 2002)

January 16, 2002
Insurance WILL pay for plastic surgery if its proven to be medically necessary. Rashes or back pain from a too big apron are examples. See your PCP and plastic surgeon to get it documented.
   — bob-haller

January 16, 2002
I recently saw my surgeon and asked about a severe rash I was having under my sagging stomach. I had read many questions on this site RE: this issue and realized I wasn't alone with the rashes. They are almost like yeast infections. Anyway, my surgeon was very straight forward about this: He said DO NOT self treat at home. Instead go to your primary Doctor everytime it happens so it will be documented. He said if you create a paper trail that always leads back to problems from hanging or overlapping skin, your insurance will almost always have to pay! Good luck!
   — [Anonymous]

January 16, 2002
You may not even need evidence of rashes and/or skin irritations. My pictures showed none of these ( because I have had none of these-- however, I will say I was prepared to "give" myself some rashes if necessary-I figured a rough towel several days in a row would probably do it)& after two appeals, my ins co has approved a panni. I see absolutely nothing to lose by at least trying. Be willing to have explicit photos taken, be willing to stay on top of your doctor to get the proper info to the ins co & to have him write the necessary appeals letter(s) and be willing to write a letter or letters explaining all of the difficulties you are having, including the rashes, back pain, etc that you may or may not be having. Then cross your fingers & don't stop trying til you have exhausted all possible avenues. anonymous by necessity (I can't imagine my ins co would see my name here, but you never know...)
   — [Anonymous]

January 16, 2002
I am 7 weeks post-op panniculectomy and brachioplasty (armlift) and both my primary and secondary insurances paid. However, the primary denied the request initially, and I had to go through their routine appeals process. I agree with all the other responses to your question, and I think that it's important to add that you shouldn't take "No" for an answer if denied. My plastic surgeon stated that it was almost "routine" for these types of surgery to be denied, but that most insurance companies will approve the process after their decision is appealed. It's almost as if they want to see evidence of just how important this really is to you. I was surprised that my armlift procedure was approved, because that almost never happens due to the "cosmetic" nature of that procedure. In my appeals process, I submitted letters from my plastic surgeon, the bariatric surgeon who performed my RNY, and my PCP. In addition, I constructed a fairly length, in-depth personal letter outlining why this "reconstructive" surgery was important to me. Finally, I included a copy of the 1996 Position Paper from the American Society of Plastic Surgeons, entitled "Treatment of Skin Redundancy Following Massive Weight Loss". A copy of this paper can be obtained from: http://www.plasticsurgery.org/profinfo/pospap/skin.htm Good luck!
   — Diana T.