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Body Image and Issues after Weight Loss Including discussions about excess skin and reconstructive surgery

Submitting Pictures to Insurance Companies

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Old 05-08-2013, 08:43 PM   #1
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Default Submitting Pictures to Insurance Companies

I am trying to get my insurance company to pay for part of my TT&BL after losing 160+ pounds. I know it is a long shot, but I figure why not try!

I have pictures to submit, but have a question.

Should I write/draw on the pictures? Either front or back? Should I include a page with "captions" (e.g. Figure 1 shows....)? Or are they self explanatory?

Any thoughts or experiences?

Chris
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Old 05-09-2013, 12:33 AM   #2
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I would ask your surgeon what he/she thinks. He/she can at least direct you to the person who does their insurance billing for info!
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Old 05-09-2013, 10:19 AM   #3
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I would ask your surgeon what he/she thinks. He/she can at least direct you to the person who does their insurance billing for info!
My surgeon does not do billing for my procedures, but I could see if they are willing to tell me anything. Thanks for the idea!
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Old 05-09-2013, 10:51 AM   #4
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My feeling is, CIRCLE and write in HUGE letters what you want them to see and keep copies for yourself.

The people at my insurance company are as dense as doorknobs and its frustrating as all heck. And I found out they scan everything and shred whatever you send them so any notes included aren't read in person by a human.

For the $$ we pay for insurance you'd think we'd get treated a *tiny* but better.

Sorry, I'm bitter fighting a claim with my insurance and every time we call everything had to be repeated for the billionth time.

Good luck!! I hope they cover something for you! Just be prepared for them to reject it all up front and expect you to give up.
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Old 05-09-2013, 12:22 PM   #5
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My feeling is, CIRCLE and write in HUGE letters what you want them to see and keep copies for yourself.

The people at my insurance company are as dense as doorknobs and its frustrating as all heck. And I found out they scan everything and shred whatever you send them so any notes included aren't read in person by a human.

For the $$ we pay for insurance you'd think we'd get treated a *tiny* but better.

Sorry, I'm bitter fighting a claim with my insurance and every time we call everything had to be repeated for the billionth time.

Good luck!! I hope they cover something for you! Just be prepared for them to reject it all up front and expect you to give up.
Because I am submitting the claim on my own, it is automatically going to a manual review board. I am hoping that since it can't go through the normal channels (according to what my insurance company told me), it will get a *little* more attention...

From what I read, I can submit 2 times, and if they decline, I can request that a board of doctors review my case in person. I don't know if that is true or not, but if the time comes, you can be sure I will try it if I have to!

I will keep you updated, and I'm sure we will be bitter together by the end of this!
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Old 05-09-2013, 12:38 PM   #6
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I agree with Elvis. Write it out, circle it, highlight it... In other words make it obvious!

Good luck!
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Old 05-09-2013, 01:05 PM   #7
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My surgeon took about 12 pictures of me and submitted them to the insurance company.

Jen
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Old 05-09-2013, 07:03 PM   #8
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My surgeon took about 12 pictures of me and submitted them to the insurance company.

Jen
Jen, Do you know if he drew on them or wrote something and attached it. My doctor will not even attempt it, so I am going at this alone.

I e-mailed the girl who submits claims for my doctor and she said to leave them blank and attach a caption-type page.

But she also told me my surgery almost never gets approved. I'm still going to fight, but am at loss of what to do. I may call my insurance company and ask them....

Hmmm....
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Old 05-09-2013, 08:21 PM   #9
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i got insurance to cover parts of my surgeries, it was an uphill battle ! for the most part Insurances will not cover cosmetic surgery ..they will however cover reconstructive surgeries. you will need to show how the skin effects you physically..does it cause chronic back pain forcing you to be on pain meds at all times? does it cause fungal rashes? do you have evidence of being treated for these things? you really need a medical professional to back you up on this. chances are they will not pay for a tummy tuck they will however pay to have your pannus removed if it hangs down so many inches past your belt line. your chances of getting approved are greater if you've had weight loss surgery btw..they tend to give "unaltered people" a harder time for some reason. good luck to you hun..i hope it all works out
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Old 05-09-2013, 09:09 PM   #10
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I am fairly confidant my pannus meets the requirements, especially since I "only" have about 15 pounds of loose (according to my surgeon) and 12 of it are on my stomach. I think I have a bit more than 15 pounds total, but I don't have a medical degree, so I will have to wait til after surgery to find out who was "right" . lol I have seen pictures of people who have gotten this surgery at least partly covered, and I think I have a lot more skin then they do. I've attached 2 pics, but don't worry, I'm wearing undies! lol
Attached Images
File Type: jpg P1010103.jpg (21.0 KB, 72 views)
File Type: jpg P1010111.jpg (19.4 KB, 76 views)
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Old 05-09-2013, 09:26 PM   #11
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May I ask a question? From the thread, I've been able to figure out that TT means tummy tuck. What is BL?
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Old 05-09-2013, 09:29 PM   #12
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I don't believe he drew on any of the pics. Just so you know, my stomach skin hung halfway down by thighs. You can see before pics on my blog. Insurance approved the surgery and paid just over $1000 of a $13,000 surgery.
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Old 05-09-2013, 09:30 PM   #13
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Default re:

Do you have any sort of redness or rashes going on under skin folds? If so, definitely take a picture of that, as I know that's one thing they use to determine if it's medically necessary.
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Old 05-09-2013, 09:49 PM   #14
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Originally Posted by Garnet2727 View Post
May I ask a question? From the thread, I've been able to figure out that TT means tummy tuck. What is BL?
Breast Lift. Sorry, since either weight loss or my surgery is ALL I think about these days, I get tired of typing out the whole thing... That's the lazy part of me! lol

Quote:
Originally Posted by CherryPie99 View Post
I don't believe he drew on any of the pics. Just so you know, my stomach skin hung halfway down by thighs. You can see before pics on my blog. Insurance approved the surgery and paid just over $1000 of a $13,000 surgery.
Jen, I spent an entire weekend reading your blog from start to finish. Yours was the most candid and forthright one I could find, and greatly appreciate you putting that out there. I feel that it has helped me mentally prepare for this summer, and remind myself that ALL the emotions I'm feeling are normal. Your skin was obviously worse than mine, but like I said, I've seen other approved pics that were not 1/2 of what I have. Plus I have the "double bubble" thing going on. My surgeon said the bottom part was pure skin. In February (weighing 208), he said I had about "1in of fat" on the upper part, and in the pictures I posted, I weigh 190, and had really increase my weight training for the previous month. And yes, if insurance paid even $1,000 of the $18,000, I would be happy!

Quote:
Originally Posted by Vex View Post
Do you have any sort of redness or rashes going on under skin folds? If so, definitely take a picture of that, as I know that's one thing they use to determine if it's medically necessary.
Oh yes! I have many more pictures showing that, but they were inappropriate to show on here! Butt nekid!
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Old 05-09-2013, 10:28 PM   #15
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Breast Lift. Sorry, since either weight loss or my surgery is ALL I think about these days, I get tired of typing out the whole thing... That's the lazy part of me! lol
Ahhh! Thank you. My brain has bubbles tonight and I just couldn't make the connection. I'm considering some surgery myself once I get to goal. The main one being my blasted chin. I've got pleats in under my chin now!
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