Question:
Do you think my chances for plastic surgery are practical?

I am almost 6 months post-op and thinking about reconstruction surgery. Thigh lift and tummy tuck are the two high ones on my list. Since my insurance paid for my lap rny, I am hopeful they will follow suit with the reconstruction surgeries (but not holding my breath). In my insurance booklet, I found two quotes that pertain to reconstruction/plastic surgery. These are the ONLY info in my booklet about such. They read that they will NOT pay for the following- (I put what I thought was important in caps.) "PROCEDURE PERFORMED MAINLY TO IMPROVE APPEARANCE OF THE COVERED PERSON, unless it is (a) treatment of congenital defect or birth defect of a newborn child; or (b) cosmetic surgery for repair of damage sustained in an accident and the charges are incurred within one year from the date of the accident".....and....."the treatment of obesity, including, but not limited to: gastric stapling, gastric bubble, bypass surgery, diet-based weight loss programs, exercise programs or gym programs. For treament of morbid obesity and RELATED MEDICAL CONDITIONS, the plan will pay for medical or surgical treament of morbid obesity, but will not pay for weight loss programs, or FOR COSMETIC TREATMENTS.".....I am very aware that it is all in how the surgeon words their paperwork and that it must be spelled out that it is medically necessary, but how would you take those quotes? Though I am a devout pessimist, I don't think this is bad news for me. Nowhere does it state anything about reconstruction surgery and I also think that maybe since they paid for the WLS, they may pay for the skin removal since it was a product from the WLS. Comments, please?..........Karen (lap rny- 9/20/02- down 118 pounds)    — karmiausnic (posted on March 15, 2003)

March 14, 2003
This sounds like standard wording to me...they won't cover cosmetic surgery, but will cover reconstructive if deemed to be medically necessary...same with WLS, if the diagnosis is morbid obesity and considered medically necessary. So, start documenting every rash, back, neck, shoulder pain, etc., with every doctor you see, and make sure they write your complaints in their office notes because the Ins. Co. will probably ask for copies of those. Good luck!
   — Leslie F.

March 15, 2003
Karen, anything is possible! Just like the previous poster said, document anything that bothers you pertaining to the areas you want reconstructive surgery on. Even if it is just a small rash, go to the doctor so he can see it. If it is pains, go to the doctor, any little thing counts. Also, take pictures! They can go a long way with insurance companies, if they can see how much the skin hangs or how bad a rash is, more opt to cover it. Doesn't hurt to try! Goodluck to you! By the way- congrats on excellent weight loss!
   — Lezlie Y.