My WLS office called today about my hernia repair and wanted to re-enforce the necessity of having the hernia repaired so that it "doesn't mess up my digestive tract." I called the insurance co. and explained everything to them and asked about having the extra skin taken off at the same time. If I can get the PS to write it up about medical necessity and a letter from my back physician, then it will probably get paid for. So I'm going Monday at 8:00 a.m. to see about getting the process started. Cross everything for me, because there is a possibility that it can be paid for and it can be done by the first of the year!!!! Geez, I've worn a hernia belt for over two years now and just don't know what I would do without it. LOL!!!
A friend had a hernia repaired and got a tummy tuck at the same time. Her hernia was due to carrying a rather large baby when she had a very small frame, though. She was two sizes smaller when she had healed from the operation and looked great.
good luck Nancy!! Havent been posting much but do hope to take time and get back into the groove of being more strict with myself. Ive been sluffing but staying legal and so im in a stuck position!! Darn scales is just staring at me in defiance!! THought i might try the five day pouch test but dont know a lot about it.. anyone have some good ideas on this? Nancy and i had our surgery at the same time and shes about ready to run off the scales ahead of me!! Maybe we all tend to get lacks after a year out... Im not giving up just need to regroup!!! Hows everyone else coping with there new lifestyle changes? Let us know your results soon Nancy on the insurance issue. i might have to have some excess skin removed also !! ALL OVER THE BODY!!!
stay safe and keep warm, it snowed here today.. carvinmom in montana
Wow! Here are the three criteria before they submit to insurance: Must have lost at least 100 pounds, one or more years out, and panniculum must hang to or below pubis area. Cost if insurance doesn't cover:
Panniculectomy: $8,735 plus $2,500 extra for abdominal muscle tightening, Abdominoplasty: $6,185; Belt Lipectomy: $11,255 (oh does include overnight fee on this one); Brachioplasty $5,325 and much more. These are cost associated with the hernia surgery and by themselves will cost more.
Doctor is recommending the whole she-bang, but I'm not independently wealthy and are just hoping the insurance will cover the panniculectomy. He is concerned also about how large the hernia is and where it is at; and because this is my third hernia would like me to have the abdominal muscle tightening. He said there are no studies done to show that extra skin pulls on a damaged back and is a medical necessity. (Bullfeathers)! I have to go to my PCP and have him write me a letter of necessity and I have to write a letter about my cleaning regiment, topicals, etc. As I suspected the extra skin is pulling down on my ability to take a deep breath, but don't know if that will come into play either. I had to get nakie and the insurance person took pictures to be submitted. YIKES!!! Have an appointment with my PCP on Friday. He has asked me more than once if I would be having it done, so feel he will be a good resource. The panniculectomy will go from hipbone to hipbone and won't even touch my "muffin top", that is a whole new ball game. All of my scars are vertical, so figure I"ll look a lot like a tic tac toe board, if this one gets done. Figure my pubis area, down will be about a size 10, but the muffin top a 12! LOL!!! Well, just have to wait and see. If anyone wins the lottery, please remember me!! LOL!!! Oh, breast lift with implants: $8,915; so you might want to throw that in also. Wish I'd been a better girl with year so Santa would give me PS for Christmas. Probably will get BS instead of PS from insurance company!!! LOL!!! What will be, will be.
A friend had a hernia repaired and got a tummy tuck at the same time. Her hernia was due to carrying a rather large baby when she had a very small frame, though. She was two sizes smaller when she had healed from the operation and looked great.
Kitty
Oh yeah, that's what I'm hoping for. Just waiting for longer term maintenance and a chance to save the bucks for the tuck part. Ins will pay for anesthesia and hernia repair but plastics md needs cash.
Talked with my PCP today and asked him for a letter of medical necessity for my abdominalplasty. He says he doesn't feel that is his area of expertise and that I really need to get the hernia taken care of. I started boiling, but calmly, said, "Why should I have the hernia taken care of 8 to 10 pounds of hanging extra skin is just going to cause another one?" Then I asked him if he thought 8 to 10 pounds of extra skin would cause me to have continued severe back pain, and would cause me to have my back surgery sooner than later. So, he stared at me for a while and told me that his girl would call me and I could pick up the letter!!!!! Am anxious to see what will be in the letter. (Fingers crossed) The last two visits he is the one that has brought up about the abdominalplasty. Go figure! He also told me that one of the girls that used to work in the office paid for her own. Unless I win the lottery, or my fairy godmother shows up, it ain't happening! I'm off next to get a letter from my orthopedic back specialist about the severity of my spine deformity and need for surgery. (Crossing my fingers). Yes, my hernia is large and my insurance will cover it, but if I can get the other done......I've already had five abdominal surgeries, multiple other surgeries, three big babies and my gut is shot, along with my back and knees and would like to get everything done at one time and not three different surgeries. For all of you young people, get the surgery NOW, before you tear up the rest of your body. If the PS doesn't happen, that is that. But, if I can get it done YIPEE!
WOW!!!! this is really complicated! it does sound, though, as if the PCP has figured out what to say. but from what i've heard, the more docs that chime in and say it's needed, the better it is! sooo go collect those letters!!!
PS Consult
