Panniculectomy Surgery
 

Considered cosmetic, and in NJ you are TAXED for it, even though the tax costs more money to collect than it brings in, go figure. That is Jersey for you, corrupt and inefficient.
Anyways, it is basically the same thing as a tummy tuck. I had both, it was kinda an inseperable procedure.

It is something I'd definitely get when I get closer to my goal weight.

Cosmetic here in TN too...i had doctors saying all kinds of medical issues it was causing me. I got to within about 30 pounds of goal weight and still had this HUGE gut. No matter what the docs said and documented, Blue Cross blueshield of TN said no way...they didnt even take it into account. Their theory was i should have never let myself get in that condition anyway. Kind of like when insurance companies will pay for "eating disorder issues", but they only consider eating disorder issues anorexia or bulemia..."if you eat too much you are just a lazy glutton, people with "real" eating disorders have psychological issues"....that is what one insurance woman told me while she was laughing at my question of why they didnt consider obesity an eating disorder. Nice huh? Sorry, can you tell i have issues with insurance companies? ha ha
Anyway. I want one (a tummy tuck) SO badly when i lose weight. I think that will be my BIG reward to myself.

Woohoo!!! I am soooo lucky (kinda). I don't have to deal with crappy insurance companies like blue shiled. Trust me, they suck everywhere, not just TN, NJ, or anywhere in the U.S. Since my husband retired from the Navy, we have TriCare Prime and all my bariatric surgeon had to say was that I had skin breakdown and chronic fungal infections and recurring cellulitis (all true, unfortunately) and I never had a problem. The insurance approval happened before I could bat an eye. It seems like the larger insurance corporations make things much more difficult, just because they can and justify it by calling it a means to avoid insurance fraud. Why?!?! So everyone has to pay for criminal fraud, instead of just the criminals. To add insult to injury, I don't even have to pay a copay for anything since it's considered therapeutic as opposed to cosmetic. The procedure I will be having is a fleur de lis abdominoplasty. My reward to myself when I maintain my personal goal weight will be breast reconstruction. I never lost any weight from my right breast, but my left breast went down about a cup and a half. Hmmm, I could probably get that justified, but I will definitely pick my surgeon for that, so I don't mind the copay. Good luck to everyone in here!!

Woohoo!!! I am soooo lucky (kinda). I don't have to deal with crappy insurance companies like blue shiled. Trust me, they suck everywhere, not just TN, NJ, or anywhere in the U.S. Since my husband retired from the Navy, we have TriCare Prime and all my bariatric surgeon had to say was that I had skin breakdown and chronic fungal infections and recurring cellulitis (all true, unfortunately) and I never had a problem. The insurance approval happened before I could bat an eye. It seems like the larger insurance corporations make things much more difficult, just because they can and justify it by calling it a means to avoid insurance fraud. Why?!?! So everyone has to pay for criminal fraud, instead of just the criminals. To add insult to injury, I don't even have to pay a copay for anything since it's considered therapeutic as opposed to cosmetic. The procedure I will be having is a fleur de lis abdominoplasty. My reward to myself when I maintain my personal goal weight will be breast reconstruction. I never lost any weight from my right breast, but my left breast went down about a cup and a half. Hmmm, I could probably get that justified, but I will definitely pick my surgeon for that, so I don't mind the copay. Good luck to everyone in here!!

Also, a lot of times surgeons will not operate on you if you are still considered "obese" because often that is something that can preclude you from that type of "elective" surgery. Just an FYI.

it's not an easy answer. and it ALL depends on your insurance. as noted above, if you have skin breakdown, chronic fungal infections, 'functional issues,' in short - what the insurers consider to be MEDICAL issues [rather than cosmetic ones], they'l cover it. AND coverage also depends on how big it is - the volume of it - if it's down to your knees [and that happens to some folks!], and you're living on oral or topical antifungals, chances are good that the insurance company will cover it.

sooo, as with everything that's associated with this surgery - check with your company to find out what hoops they require from you!

in general, they won't approve something that's considered a tummy tuck, but what we're generally looking for is something that's FAR more involved and FAR more medically necessary than just removing a little bit of excess skin.

as for being considered still obese, one of the catch 22's here is that some of these aprons can weigh upwards of 30 pounds - and that's enough to tip someone who's otherwise of normal weight into the obese category!

Well, often they do both at the same time and essentially it IS the same thing, the only difference being that people with pannuses have more that needs to be removed. Take it from one who knows and has actually had the surgery. If you are thinking of getting it though, it is no picnic but definately worth it. :)

But, yes, if it is something that is FAR more medically necessary, (and you know what that entails for insurance companies) then they MIGHT cover it.

one more insurance related point - in some cases, because the pannus is considered to be the result of surgery, and not of old-fashioned weight loss, some insurance companies are more likely to cover it for someone who's had WLS than for someone who hasn't.

something to ask about, at least!

Jiffy,

That is what I heard about Kaiser. They are willing to cover it if you had WLS but not if you lost the weight otherwise. Kind of pisses me off but oh well.

Jiffy, what do you mean that the pannus is considered to be the result of surgery? Just not following that line of thought.

Edited : I think I know what you're saying now. If the pannus developed as a result of surgery.... Gotcha.

Yeah, but as we (those who have been morbidly obese) all know, the pannus is there before surgery as well, only more filled out.

Also, Nelie, that really p***es me off that being a "cheap" loser for your insurance company (meaning you are able not to require the expense of wls surgery) means that they won't meet your needs afterward. They should kiss your (and my) feet for not incurring that expense on them. Pooh on insurance companies.

this whole question of whether there's any possibility of insurance companies covering the panniculectomy IN A PERSON WHO'S HAD WLS obviously has no simple answer. bottom line - ya gotta check with your insurance company.

but it also points out the DIFFERENCES in medical treatment and patient management that WLS folks have compared with people who lose weight the old-fashioned way. while we're certainly happy that people who haven't had surgery stop in and give their opinion, they're able to talk about THEIR EXPERIENCES ONLY, and therefore their comments may not be entirely relevant for those of us who've had WLS.

trust me - it's REALLY unfair for ANYONE who's lost huge amounts of weight through ANY means to be denied insurance coverage for a panniculectomy, but we can't control this.

Jiffy,
Are you saying some insurance companies cover the surgery if you have previously had surgery (such as C-section) which caused it afterwards. 2 children, 2 C sections and weight gain later I have an awful one.