I heard about this site from my wife who taped the View . I really need help in so many areas. I am hoping all of you will be able to answer some ?'s I have lost all my wt and my insurance denied me to have the excess skin removed on my stomach. The plastic surgeon said that its normal to have the insurance deny the first time. Anyone have any ideas?

The best thing to do is find out what WILL qualify you to get approval from you insurance company. In other words, make the phone call or send an email...ask the question...then do everything that they ask. I had to wait for three months in order to get everything documented for them. Jump through all of the hoops and it should go through.

I can offer no sugg.. but good luck!! I may be in your boat one day so thanks for asking!

Hi! Welcome to the n'hood! Just wanted to encourage you to fight the good fight...as Kim said "jump through all the hoops"....I had 10lbs of excess skin removed from my tummy area about 3 years ago and I had no problem getting my ins to pay but it did take a little while to get their "approval"...I went to a Dr whom I knew accepted my ins and they did all the work for me...sorry I can't be of more help...keep us posted on your progress...

Blessings!

Hey there, BigDog!
I'm only 4 mos out so can't give any advice. I just wanted to pop in here & tell you, "Welcome to the Neighborhood!" Glad your wife got your in touch with us.

OK I heard this through my support group so take it with a grain of salt...

If your insurance company is denying the skin removal, it is most likely because they consider the skin removal as a cosmetic procedure and we all know that insurances don't DO cosmetic surgeries.

If you have rashes in those areas, if you continue to go to the Dr. and they continue to document that these rashes are caused by the excess skin, they will be more apt to change the cosmetic diagnosis to a necessity.

Anyway, thats what several people did...some even self caused rashes so they could get the "paper trail" going and get the procedure done faster.

I fought like mad to get my insurance to cover my wls. I got denied twice. I almost had a coronary when I realized that they approved my panniculectomy 7 days after they received my pictures, paperwork! What? Did I read that right? I cried. They did not cover the muscle repair, but i had it done anyway. Here is the criteria set by my BCBS of TN policy:


Lipectomy
DESCRIPTION

Lipectomy is a surgical technique that is used to cut and remove unwanted fat deposits from specific areas of the body. These areas include: chin, neck, cheeks, upper arms, above the breasts, abdomen, buttocks, hips, thighs, knees, calves and ankles. It is not a substitute for weight reduction, but is a method of removing localized fat that does not respond to dieting and exercise. A lipectomy is done for cosmetic reasons or to treat functional impairment.

Functional impairment can be defined as having extensive redundancy of skin and fat folds in varied anatomic locations causing functional problems. This can result from losing or gaining massive amounts of weight. These areas include medial upper arms, breasts (male and female), the abdomen and medial thighs. An abdominal fold hanging below the pubis would be one example of functional impairment and the surgical treatment of this condition would be spoken of as an abdominoplasty.

POLICY

Lipectomy for functional impairment is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)

Lipectomy for any other condition is considered cosmetic.

MEDICAL APPROPRIATENESS

Lipectomy is considered medically appropriate for individuals with symptomatic functional impairment if any of the following criteria are met:

• The individual's condition is beyond normal variation in body morphology with impairment of hygiene (e.g., recurrent skin infections, chronic rashes, uncontrollable intertrigo, subcutaneous abscesses) that is refractory to medical management; or
• Panniculus hangs at or below the symphysis pubis, as demonstrated by pre-operative photographs; or
• The individual has documented panniculitis.

I had a letter from my doctor stating that I had rashes, and also my pictures proved that my panniculus hung down past my symphsis pubis. I have pics of my plastic surgery consult on my website under "categories" and "plastic surgery". I could not see my pubic hair region without physically lifting up my tummy skin! Anyway, hope this helps.