Question:
Does insurance cover any of the plastic surgery?
It's only been 6-months since my surgery and I'm down 91 pounds and roughly 54 inches. I believe I'll need a tummy tuck, thighs and arms. I've heard that in some instances these three procedures may be covered by insurance. Has anyone had any or all of these and were they covered? — Susan K. (posted on June 8, 2004)
June 7, 2004
My Tummy was covered. I got my breast covered (my company ordered them to
pay) but not the arms.
— star .
June 7, 2004
My abdominoplasty was approved on appeal, but I won't even ask for thighs,
arms, or anything else becasue I know it is not covered. Read your summary
plan description for your particular insurance plan and you may find the
answers there!
— koogy
June 8, 2004
I was able to get my tummy tuck w/ a little lipo approved by my insurance
company. The key to approval is to be prepared for anything..write an
appeal letter before it's even denied. Call the insurance companies as well
as your doctor everyday. Stress the importance of this surgery to you
— Michelle H.
June 8, 2004
In order for medical insurance to cover any of the procedures, it has to be
considered medically-necessary, not cosmetic. So, depending on both the
person (how much loose skin is there, and in what MEDICAL ways does it
cause problems--e.g. skin rashes, mobility issues, back aches, etc.), and
the insurance policy (does it cover reconstructive surgery of any kind, how
severe does the medical condition have to be for surgery to be covered,
etc.). Some people are not able to get any of the reconstructive surgery
covered, others are able to get quite a bit covered. In the case of a
tummy tuck, insurance may cover only the simpler version that removes
excess skin, when you want to also have the underlying muscles tightened.
In that case, you would have to pay the additional fees for the parts not
covered by insurance. Some people are also able to get the hospital and
anesthesia covered if they have not-covered reconstructive surgery done in
conjunction with a hernia repair (insurance pays for the hernia repair and
associated anesthesia and hospital costss, you pay the extra surgeon fees
for the additional surgery done at the same time). It seems nearly
impossilbe to get arms covered as that is almost always considered cosmetic
(hard to show a true medical necessity for it). The same goes for thigh
lifts, though sometimes repeated skin rashes if the loose skin rubs against
the opposite thigh will get it covered. I was just approved for a basic
panniculectomy with hernia repair, but was denied for the arms, removal of
extra skin from the hips, liposuction of the pubic area, and removal of
excess skin that flabs over the top of my bra sides. I'll also pay extra
for the muscle tightening done with the panniculectomy. While I'd love to
have insurance cover more, I do have to agree that the hanging abdominal
skin is the only part that is justifiably medical--the rest is mentally
necessary, but not covered by insurance. My advice is to wait until you
get to or very near where you're going to end up weight-wise and then give
it a try. In the meantime, document every medical problem that you have
because of the extra skin, and see your PCP for any rashes or back aches
you have to back up medical necessity later.
— Vespa R.
June 8, 2004
I just got a panniculectomy approved along with my hernia repair. My PS
said that he had to do the muscles anyway with the hernia so I will end up
with an abdominoplasty. I had to work hard for this, getting denied twice
and having to go to an external review through the NY State Insurance
Board. My arms and legs could definitely use some work, but I would never
get approved and won't try. read my profile to see how I went about the
process. The big thing is to have your Drs document anything that would be
helpful to your case. Good luck!!
— Fixnmyself
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