HUGE motivation from Doc...re:excess skin
virelay129
Posts: 43 Member
My doctor has been monitoring me for several years in relation to meds and weight. I went to see her about 2 weeks ago and she mentioned my 21 lbs drop (their scale weighed me before I did my first weigh-in here) and asked if I ad any questions. My first and only was about the excess skin...we both agreed that most likely I will have quite a bit with how long I've been overweight and other factors.
She then said, that if I reach <159.4 (the top of healthy for my height) and maintain or go down for 18 months she will do everything she can to deem the excess skin removal as "medically necessary". I LOVE MY DOCTOR!!
She knows its a big concern, and is already showing to be an issue....this was such and uplifting motivator. XD
Can not wait to reach that mark!!
She then said, that if I reach <159.4 (the top of healthy for my height) and maintain or go down for 18 months she will do everything she can to deem the excess skin removal as "medically necessary". I LOVE MY DOCTOR!!
She knows its a big concern, and is already showing to be an issue....this was such and uplifting motivator. XD
Can not wait to reach that mark!!
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Replies
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That's fantastic
What a great motivation! Congratulations on your loss so far! 0 -
Well I can see excess skin as being medically necessary to remove. If you have large skin folds aren't you at higher risk of infections in that area?
Which will be cheaper, surgery or a lifetime of ointments, creams, antibiotic or what ever you take for skin infections.0 -
virelay129 wrote: »My doctor has been monitoring me for several years in relation to meds and weight. I went to see her about 2 weeks ago and she mentioned my 21 lbs drop (their scale weighed me before I did my first weigh-in here) and asked if I ad any questions. My first and only was about the excess skin...we both agreed that most likely I will have quite a bit with how long I've been overweight and other factors.
She then said, that if I reach <159.4 (the top of healthy for my height) and maintain or go down for 18 months she will do everything she can to deem the excess skin removal as "medically necessary". I LOVE MY DOCTOR!!
She knows its a big concern, and is already showing to be an issue....this was such and uplifting motivator. XD
Can not wait to reach that mark!!
I am very happy for you, but it sounds like your doctor is iffy. I read that as your doctor has no issue falsifying medical records and admitted she would be committing insurance fraud by falsifying your record.
Sorry, that just needed to be said. But your determination and new motivation I hope work out for you. You should be really proud.
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I don't read it as saying that. I read it as her using all possible (legal) avenues to try to get the insurance company to realize it is 'medically necessary'.
I am very happy for you, but it sounds like your doctor is iffy. I read that as your doctor has no issue falsifying medical records and admitted she would be committing insurance fraud by falsifying your record.
Sorry, that just needed to be said. But your determination and new motivation I hope work out for you. You should be really proud.
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virelay129 wrote: »My doctor has been monitoring me for several years in relation to meds and weight. I went to see her about 2 weeks ago and she mentioned my 21 lbs drop (their scale weighed me before I did my first weigh-in here) and asked if I ad any questions. My first and only was about the excess skin...we both agreed that most likely I will have quite a bit with how long I've been overweight and other factors.
She then said, that if I reach <159.4 (the top of healthy for my height) and maintain or go down for 18 months she will do everything she can to deem the excess skin removal as "medically necessary". I LOVE MY DOCTOR!!
She knows its a big concern, and is already showing to be an issue....this was such and uplifting motivator. XD
Can not wait to reach that mark!!
I am very happy for you, but it sounds like your doctor is iffy. I read that as your doctor has no issue falsifying medical records and admitted she would be committing insurance fraud by falsifying your record.
Sorry, that just needed to be said. But your determination and new motivation I hope work out for you. You should be really proud.
The doctor is "iffy?" What justifies that conclusion? FWIW, excess skin can easily produce serious medical problems. The reason for an 18 month wait is to be sure that the OP can maintain. Sheesh. I am use to folks being judgmental on this forum but this takes the cake.0 -
Congrats in advance virelay! You probably won't even need it but I can just imagine it's nice not to worry0
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Fantastic news! Go get it!0
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excited for you! don't let the negative comments get you down.
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To me this reads: "she will do everything she can to deem the excess skin removal as "medically necessary".
Insurances typically do not cover cosmetic surgery (which is what this would be). insurances will pay IF the doctor can prove it is needed (ie constant infections). Maybe it's the NyQuil I have on board, but that sentence to me sounds like the doctor will try to not be 100% truthful.0 -
littledogjh wrote: »excited for you! don't let the negative comments get you down.
Okay you need to reread my post again. I was not putting the OP down at all. In fact I said I was very happy for Her and she should be proud.0 -
Excess skin can be a health issue due to rashes, etc. It is considered medically necessary for extreme losers. Here in Canada a panni would be covered by the public health care system for someone like me.0
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OP I think your doctor is Awesome for doing everything in her power to help you
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Excess skin can be a health issue due to rashes, etc. It is considered medically necessary for extreme losers. Here in Canada a panni would be covered by the public health care system for someone like me.
Most insurance companies in the U.S. consider it cosmetic surgery. One could argue that you can get a skin infection, so they should remove it to prevent it but they don't. They typically require on going skin infections to pay for it, other wise it is all out of your pocket.if you haven't had an infection so far or in the future, chances are the insurance is not going to pay.christinev297 wrote: »OP I think your doctor is Awesome for doing everything in her power to help you
I do too, but I also don't want to see her stuck paying if insurance denies it.0 -
I am very happy for you, but it sounds like your doctor is iffy. I read that as your doctor has no issue falsifying medical records and admitted she would be committing insurance fraud by falsifying your record.
Sorry, that just needed to be said. But your determination and new motivation I hope work out for you. You should be really proud.
Oh, pish. Go rain on your own parade! Nowhere did the OP state that by "doing everything she can..." that the MD was intending to break any laws or be dishonest. Your inference is incorrect. And I'm not saying that you are putting the OP down. But your statements about the MD are mean and way off base. The MD will not be lying about the OP's weight loss (or resulting excess skin and the myriad problems involving rashes, etc. Most of us have experienced these same skin issues-- they are legitimate results of weight loss, and need to be taken seriously by doctors and insurance companies. I wish all MDs were as concerned, involved, and interested in being an advocate for their patients.0 -
countscalories wrote: »
I am very happy for you, but it sounds like your doctor is iffy. I read that as your doctor has no issue falsifying medical records and admitted she would be committing insurance fraud by falsifying your record.
Sorry, that just needed to be said. But your determination and new motivation I hope work out for you. You should be really proud.
Oh, pish. Go rain on your own parade! Nowhere did the OP state that by "doing everything she can..." that the MD was intending to break any laws or be dishonest. Your inference is incorrect. And I'm not saying that you are putting the OP down. But your statements about the MD are mean and way off base. The MD will not be lying about the OP's weight loss (or resulting excess skin and the myriad problems involving rashes, etc. Most of us have experienced these same skin issues-- they are legitimate results of weight loss, and need to be taken seriously by doctors and insurance companies. I wish all MDs were as concerned, involved, and interested in being an advocate for their patients.
Some people have no complications with their saggy skin after losing weight. They don't get rashes or anything else.how do you know her excess skin will be a health risk? You don't. No one can predict the future. If she has no complications with the skin, she would be stuck with the bill by the insurance rejecting the claim.
It would not be the first MD falsified documents, and not likely the last either.
All I was trying to say was the OP should be a bit careful since hospital bills are sky high.0 -
countscalories wrote: »
I am very happy for you, but it sounds like your doctor is iffy. I read that as your doctor has no issue falsifying medical records and admitted she would be committing insurance fraud by falsifying your record.
Sorry, that just needed to be said. But your determination and new motivation I hope work out for you. You should be really proud.
Oh, pish. Go rain on your own parade! Nowhere did the OP state that by "doing everything she can..." that the MD was intending to break any laws or be dishonest. Your inference is incorrect. And I'm not saying that you are putting the OP down. But your statements about the MD are mean and way off base. The MD will not be lying about the OP's weight loss (or resulting excess skin and the myriad problems involving rashes, etc. Most of us have experienced these same skin issues-- they are legitimate results of weight loss, and need to be taken seriously by doctors and insurance companies. I wish all MDs were as concerned, involved, and interested in being an advocate for their patients.
Some people have no complications with their saggy skin after losing weight. They don't get rashes or anything else.how do you know her excess skin will be a health risk? You don't. No one can predict the future. If she has no complications with the skin, she would be stuck with the bill by the insurance rejecting the claim.
It would not be the first MD falsified documents, and not likely the last either.
All I was trying to say was the OP should be a bit careful since hospital bills are sky high.
You're saying regardless of if the doctor is able to preapprove the surgery with the insurance company, the OP might still get stuck with the bill if there's a bait and switch? Or is the doctor a Shyster if she's able to successfully get the surgery approved because it's cosmetic?
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countscalories wrote: »
I am very happy for you, but it sounds like your doctor is iffy. I read that as your doctor has no issue falsifying medical records and admitted she would be committing insurance fraud by falsifying your record.
Sorry, that just needed to be said. But your determination and new motivation I hope work out for you. You should be really proud.
Oh, pish. Go rain on your own parade! Nowhere did the OP state that by "doing everything she can..." that the MD was intending to break any laws or be dishonest. Your inference is incorrect. And I'm not saying that you are putting the OP down. But your statements about the MD are mean and way off base. The MD will not be lying about the OP's weight loss (or resulting excess skin and the myriad problems involving rashes, etc. Most of us have experienced these same skin issues-- they are legitimate results of weight loss, and need to be taken seriously by doctors and insurance companies. I wish all MDs were as concerned, involved, and interested in being an advocate for their patients.
Some people have no complications with their saggy skin after losing weight. They don't get rashes or anything else.how do you know her excess skin will be a health risk? You don't. No one can predict the future. If she has no complications with the skin, she would be stuck with the bill by the insurance rejecting the claim.
It would not be the first MD falsified documents, and not likely the last either.
All I was trying to say was the OP should be a bit careful since hospital bills are sky high.
You're saying regardless of if the doctor is able to preapprove the surgery with the insurance company, the OP might still get stuck with the bill if there's a bait and switch? Or is the doctor a Shyster if she's able to successfully get the surgery approved because it's cosmetic?
It is kind of a combination of both. The OP (and her MD) would have to prove that the excess skin is impacting health. If it is not impacting health, they will just deny it.
As I said, the way the OP said her doctor talked to her, sounds a little iffy. If she had no medical issues from the excess skin, but the MD falsified things to have her get the surgery and the insurance company ever found out? That's fraud. Not only would she have to pay everything back, but there can be some pretty severe legal ramifications.
I honestly just want to make sure the OP keeps herself safe, because hospital bills can be ridiculously high.0 -
Hi, I work in the medical insurance industry. OP's doctor will have to provide supporting documentation in order for the insurance company to approve it (and it will need to be pre-approved).
Physicians are generally not willing to lose their medical licenses (and the other assorted costs for defrauding the insurance company).
I read this as 'My Doctor is going to work as an advocate for me to get this covered' and the fact that everyone jumps to the 'OMG FRAUD' button just makes me think everyone should take a step back.
Also, some insurance policies DO cover it as reconstructive surgery without having to 'prove' skin issues, so... please, let's just be happy that the OP has a great support network in their medical team.0 -
To me this reads: "she will do everything she can to deem the excess skin removal as "medically necessary".
Insurances typically do not cover cosmetic surgery (which is what this would be). insurances will pay IF the doctor can prove it is needed (ie constant infections). Maybe it's the NyQuil I have on board, but that sentence to me sounds like the doctor will try to not be 100% truthful.
I would be concerned about this too...not about the doctor perhaps being untruthful, but about her being enthusiastic v. what your insurance company might say.
I don't want to be a Debbie Downer (my apologies to any Debbies out there), but even when a doctor states to the insurance company that skin removal surgery is medically necessary, they don't always cover it.
You might what to call your insurance company and try to feel them out on it a little bit.
And no, to the poster above, I wouldn't have thought "fraud" in connection with this...that thought wouldn't have even occurred to me...but what doctors want and what insurance companies want can be two different things. My son needed a dental expander. I was told by the ortho that if he didn't have it, his upper teeth would cave inward during his growth period until he actually required surgery to correct it all. That was pretty scary. And that's what the ortho told my insurance company. With all the X-rays at all angles showing the current progression (he was already caving inward all along the top row). And they replied, in a nutshell, "tough darts." We're still paying it off, 100% out-of-pocket. With interest, naturally.
Ironic in a fascinating (and kind of horrible) way that insurance companies won't blink to help a man achieve an erection and get off (because we CAN'T have some random dude not jam, good God the humanity!), but tell little kids who will eventually need to have their upper palate broken and sewn back together correctly and then have a bunch of teeth removed with replacements screwed in so that he can, you know, chew, to go stag it.
I would say to the OP: GREAT that your doctor wants this for you and will fight for it, but just in case, start saving up money now.
Sock a little away here and there if you at all can. And keep losing! It's a great feeling and can be a tremendous health boost. So, way to go!
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Clarification: IF I have continued sores, chaffing, or infction(s) she will do everything she can LEAGALLY to deem it medically necessary to get it taken care of. No guarantee either way. As I am already dealing with minor infections, she is noting everything for the case, should the need arise.
Honestly I'm hopeful not to have an issue....but it's clear I will as I am already having minors ones and I'm only down 21 (her scale) and 19 inches.
Like whoa....gotta be SUPER specific here. O.o0 -
Hi, I work in the medical insurance industry. OP's doctor will have to provide supporting documentation in order for the insurance company to approve it (and it will need to be pre-approved).
Physicians are generally not willing to lose their medical licenses (and the other assorted costs for defrauding the insurance company).
I read this as 'My Doctor is going to work as an advocate for me to get this covered' and the fact that everyone jumps to the 'OMG FRAUD' button just makes me think everyone should take a step back.
Also, some insurance policies DO cover it as reconstructive surgery without having to 'prove' skin issues, so... please, let's just be happy that the OP has a great support network in their medical team.
^^
Thank you!
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virelay129 wrote: »My doctor has been monitoring me for several years in relation to meds and weight. I went to see her about 2 weeks ago and she mentioned my 21 lbs drop (their scale weighed me before I did my first weigh-in here) and asked if I ad any questions. My first and only was about the excess skin...we both agreed that most likely I will have quite a bit with how long I've been overweight and other factors.
She then said, that if I reach <159.4 (the top of healthy for my height) and maintain or go down for 18 months she will do everything she can to deem the excess skin removal as "medically necessary". I LOVE MY DOCTOR!!
She knows its a big concern, and is already showing to be an issue....this was such and uplifting motivator. XD
Can not wait to reach that mark!!
That's a wonderful Dr. You have there. ..best of luck in your journey.
If you'd like please feel free to add me...i already have excess skin and this is a procedure im seriously considering doing as well once i lose all the weight.
Again. ..i wish you all the best 0 -
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That is awesome.0
This discussion has been closed.
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