Well, I am stilll pursuing plastic surgery. In two months it will be four years I have been in my goal range, and five and a half years since I have been under 150. I am so tired of the excess skin, I would do anything to be rid of it.
Has anyone ever had any success with getting their insurance to cover some or all of your abdominoplasty or similar plastic/reconstructive surgery? (Excluding bypass patients. I have been told that it is frequently covered for bypass patients??)
This will be my second try. I also have hernia which I am hoping to have repaired at the same time.
Insurance wouldn't cover it for me. I couldn't even claim tax back as a medical neccessity (in my state plastic surgery-- even reconstructive after massive weight loss has a LUXURY TAX on it and so that upped the total bill a few THOUSAND). Yeah, it's considered a LUXURY here in New Jersey for someone to have a normal body. Nice.
My plastic surgeon wrote an impassioned letter to my insurance company but it didn't do any good.
I haven't heard of anyone who's had insurance pay who isn't a WLS patient -- but that doesn't mean it can't happen. It all comes down to medical necessity and your ability to show that the skin causes medical problems, like rashes and skin ulcers. Do you have issues that your doctor could document and submit?
Even if insurance only covers the hernia repair, I wonder if procedures could be combined to save some money?
Good luck, Kelly! I know how frustrating this can be!
Well, once again I am in tears, and my appt. isn't even until 9/24!
I spoke to someone at the office who told me flat out that unless I am a WLS patient, insurance will not pay for any of it. They can/will repair the hernia at the same time and bill the insurance for that portion only.
I am still going to keep my appointment and speak to the surgeon (see what he can combine, like you mentioned Meg) but I am so upset. I don't understand it ... why why WHY is it that you can lose 100 lbs from WLS and get the surgery, but when you eat right and exercise on your own and lose 100 pounds, that doesn't count?
I am so so disappointed. Even though I knew 99% that this would happen again, I sorta was hoping for a miracle.
Kelly, I just don't know the answer to "why". I call us the orphans of the medical system because no one wants to provide services or assist those of us who have lost large amounts of weight without surgery.
It drives me bananas that our local medical school has a program called "Life After Weight Loss", with psychological counseling, nutritional services, support groups, and a complete plastic surgery program. Guess what? It's for post-WLS patients only. I really could use some of those services and support, but nope.
I guess the common perception held by doctors and the public is that large weight loss is only possible through surgery, so we're not supposed to exist. Even though we saved our insurance companies countless thousands of dollars in surgery and after-care expenses, there's not a dime available to assist us. We're totally on our own.
I'm so, so sorry that you've run into this brick wall too. Maybe, just maybe you can talk to your doctor in September and see if there's a way that you might qualify. If you're having any problems caused by the excess skin, take photos and try to document them. I'm just so sorry.
I guess the common perception held by doctors and the public is that large weight loss is only possible through surgery, so we're not supposed to exist.
Exactly.
I am sorry, too, Kelly. It really just isn't fair.
And Meg, that is completely ridiculous that they won't support you! Maybe because WLS requires numerous doctor appts and surgery(ies) that they are more supportive of it at the medical school? Maybe it is sponsored by the surgery department of the school? Maybe the conception is that if you can lose weight on your own then you should be able to sort any and all other problems out on your own, even if it requires skilled surgical care? Ugh.
And Meg, that is completely ridiculous that they won't support you! Maybe because WLS requires numerous doctor appts and surgery(ies) that they are more supportive of it at the medical school? Maybe it is sponsored by the surgery department of the school? Maybe the conception is that if you can lose weight on your own then you should be able to sort any and all other problems out on your own, even if it requires skilled surgical care? Ugh.
Or maybe they just don't care. We're invisible; we don't exist. Am I bitter?
It makes me so very thankful for 3FC because here, we DO exist and can find support, knowledge, and friendships.
I simply can not believe what I am hearing. I had no idea that WLS patients are covered for surgery. I was pretty certain that non-WLS patients were NOT, but I thought it was the same for those that have had WLS. It is one of the most ridiculous, unfair things I have ever heard of. And boy oh boy does it pi$$ me off. You would think the insurance companies would be grateful that we did it on our own. Wow. Just wow.
Kelly, I am so sorry that you are going through this. I feel for you. I hope that you get some satisfaction and that your doctor can find a way to get you to qualify.
And to the ignorant medical world and insurance company world -
Helloooooo. We exisit. We really do. We're right here. Open up your darn, dopey eyes.
Ladies, all.......I feel your pain.....I share your outrage.
I, too, know WLS women who have had the abdominoplasty covered. It seems so wrong to me that I did it the old fashioned way with diet and exercise, cost my insurance company nothing...actually reduced its cost by not needing high blood pressure medication anymore and having no more knee problems..and yet..NO...no help with the excess skin and subcutaneous fat....but I have a much bigger beef with insurance
Insurance pays for WLS.....no questions asked........30K......no questions these days........but for those who seek alternative treatments, particularly weight loss counseling.......physcologists, etc....forget it! It pays for drugs and surgery, but for the non-drug, non-surgery, more wholistic approaches to weight loss, forget it.......that is for sure, for sure, a direct result of lobbying efforts on the part of pharmaceutical companies and whatever industry in in tight with the surgery option....we need to get informed on these issues and raise cain in the next election........it may seem like a lost cause, but if we don't, who will???
I have a friend who cited "mental anguish and emotional distress" and got her excess skin removed through her insurance. She lost about 150lbs "sweating to the oldies" and eating properly, but when she got down to a stable good weight, she discovered what a "monster" she had become (that was in her own terms). I spent ages trying to tell her that she looked really good and that she shouldnt worry about the little excess skin she had.
I think it all really depends on how good your insurance is. Her parents were in the military, so from experience, military insurance policies are some of the best out there.
It's so damn unfair. I suffer from depression and anxiety and the skin and stretch marks are making it worse. They have NO problem paying for countless meds and visits to the therapist and psychiatrist. I don't get why they don't se that THOSE are going to be incredibly costly over time. I know all my mental health issues will NOT be solved by surgery and I'm not even to my goal yet (YET being the opeative word ) but now that I am feeling physically better and more confident - if I didn't have the skin issues I would be much better.
GRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR
I'll definitely try going through my insurance when I get down to the point where I can have the excess skin removed. (I have quite a bit now but I wouldn't want to go for surgery until I am comfortably in the 100s)
A few years ago, I was in a weight loss program with my current insurance (Kaiser). The weight loss program was required for WLS patients but it was also available to anyone else who wasn't on the WLS track. Anyway, we were told that for WLS patients they will remove excess skin but not for anyone else.
I even saw a post from someone else on this forum that said they had Kaiser and they casually mentioned to someone in Kaiser that they would like a tummy tuck and that they had WLS surgery a few years ago. That person told them that they could get a tummy tuck since they had WLS, so they looked into it and they got it. I was amazed.
I am going to definitely need surgery when I reach goal.
This is my question - does anyone have the specific criteria under which insurance covers plastic surgery for WLS patients? It seems if the same criteria is met by a non WLS patient as a WLS patient who has been approved, the non WLS patient should be approved as well. Also, many insurance companies have a standard refusal policy, ie: for certain [qualified]procedures under certain circumstances, they will refuse a certain number of times. I work for a class action plaintiffs' law firm, I am told the refusal policy can be as high as 10 times before approval is granted in some cases! They save lots of money because most sane people will assume they have to give up after 3 or 4 refusals. I do not know what the policy is for this issue and sometimes the only way to find out is through legal action.
If some of you will get me the actual verbiage used in the responses you received and find out what your insurance companies' specifically use as criteria for WLS patients that were approved, I will ask one of our partners who specializes in healthcare about it.
Casandra - Can you find out the name of the insurance company that covered your friend who was approved under "mental anguish?" Thanks - Goldie
Anyone ever have insurance help pay?
me off! 
) but now that I am feeling physically better and more confident - if I didn't have the skin issues I would be much better. 
