with insurance companies who deal with customers and weight loss. Last fall, I went to a local plastic surgeon who is covered under my insurance to discuss having a brachioplasty done on my arms. He took the blue marker to my arms and everything and marked off where exactly it was that he'd have to take the excess skin/fat off my arms and took Polaroids and sent everything off to my insurance company. A few weeks went by and they received back a letter from my insurance company stating that they saw 'no medical reason' for my having the surgery and refused to cover it, BUT (and this is where it ticks me off) had I opted to have a gastric bypass when I weighed over 300 pounds, they would have covered that. What the heck?! Is that not crazy? I know I'm always talking about my arms on here, but you guys gotta see a pic to know why it bugs me so much.
Last edited by LesnarsTXF5Diva; 07-06-2005 at 04:10 PM.
It does suck, but it's also true. It's not a medical procedure because your health won't improve, whereas the gastric bypass would have improved your health by helping you to lose weight. However, had you had the bypass, I bet you'd have a LOT more loose skin (my boss from a previous job had bypass--which was covered by her insurance--and recently had to have an entire lower-body lift to remove all the excess skin from her legs, thighs, hips, and stomach, which she had to pay for herself--THOUSANDS of dollars!).
I think the only shot you've got is if the excess skin causes a lot of irritation--rashes, sores, and the like. If this is the case (and can be proven by a doctor), then you might have a chance because the surgery would improve your physical health.
I certainly understand your frustration, and I'm really not trying to shoot you down here, but I also understand the insurance company's point of view (maybe as a result of working on the Medicare projects at work too much!). The way they look at it, they would rather spend $$ for your bypass to avoid spending more on you in the long run (high BP medication, diabetes treatments and supplies, and any other of the multitude of health risks that come with being obese). However, spending $$ on your plastic surgery won't save them anything later on, so they don't think it's important. It really does suck, but it's normal in the big, evil system we have come to rely on
On a brighter note, though, despite your arms, you've got a great figure! You've been so successful in your weight loss, and your stomach (at least what's in the picture) looks normal with no saggy skin or anything. I can only PRAY that would happen for me, since I have been fat my whole life. Congratulations!
And if you had decided to have the gastric bypass, then not only would the surgery have been covered, but the inevitable plastic surgery to follow would have been covered as well!! That's what frustrates me so much about it. For those of us who are able to lose the weight without surgery, there is almost zero chance of any reconstructive surgery being covered by insurance. Not that it affects me personally that much since I don't even have insurance to start with, but I feel very strongly on the subject and it just doesn't seem right to me.
It must depend on the company--like I said, my previous boss had the bypass, and her insurance covered it (after a LOT of battling, since they refused to cover it at first), but when she needed the plastic surgery, they were not willing to budge, and she had to pay the over $10,000 for the lift/skin removal herself.
I work for a health insurance company in the UK we don't pay for weight loss surgery OR reconstructive work after weight loss. We don't pay for the removal of non diseased tissue, period. It seems so unfair when you see pictures like yours. I am so sorry you have had this disappointment. If I win lottery at the weekend I will send you the money!
That just really sucks. I would try to fight it. You can also write to your congressman(woman), senators and work to get this changed. They are all on the let's get healthy kick but I don't think they've fully thought all this out and it isn't fair that they will cover for the bypass surgery and plastic surgery for it but not cover if you lose the weight on your own.
Sometimes the stupidity of bureaucratic decisions has no boundaries. In Quebec, we have a Medicare, paid by the government. Most common medical interventions are covered. However, in some non-frequent cases there has to be some sort of review before the intervention is authorized. A few years ago, at approximately the same time, government accepted to pay for a teenage girl breast enlargement but refused the surgical intervention that would have cured a young children hearing problems.
with insurance companies who deal with customers and weight loss. Last fall, I went to a local plastic surgeon who is covered under my insurance to discuss having a brachioplasty done on my arms. He took the blue marker to my arms and everything and marked off where exactly it was that he'd have to take the excess skin/fat off my arms and took Polaroids and sent everything off to my insurance company. A few weeks went by and they received back a letter from my insurance company stating that they saw 'no medical reason' for my having the surgery and refused to cover it, BUT (and this is where it ticks me off) had I opted to have a gastric bypass when I weighed over 300 pounds, they would have covered that. What the heck?! Is that not crazy? I know I'm always talking about my arms on here, but you guys gotta see a pic to know why it bugs me so much.
I'm amazed you could have gotten your insurance company to approve gastric bypass if you decided to go that route. I know that is still a difficult, long process.
I can sense your frustration, but I can also see that it clearly isn't a medically necessary procedure. Heck, contact lenses are still cosmetic, so I'm afraid a skin reduction will be viewed as such for the time being. If it is really important to you, take out a loan and get it done....you are worth that with all your hard work you've put into losing your weight.
I have a bone to pick...
