Insurance for excess skin

pfgaytriot

Great job on the weight loss! That's an amazing amount of weight to lose. Congratulations!

My wife lost a significant amount of weight, as did I, but she was left with a significant amount of skin while I was not. She's was medically approved for the surgery when she had to have an emergency appendectomy, but we'll be holding off for a year or so because we want to have kids first.

Below is a list of criteria that has to be met before Anthem (my insurance provider) will cover skin removal, aka Panniculectomy and Abdominoplasty. Note the significant weight loss circumstances before deciding to move forward with skin removal surgery.

Panniculectomy is considered medically necessary for the individual who meets the following criteria:

The panniculus hangs below the level of the pubis (which is documented in photographs); AND One of the following:

• there are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers, that do not respond to conventional treatment (for example, dressing changes; topical, oral or systemic antibiotics, corticosteroids or antifungals) for a period of 3 months; or
• there is documented difficulty with ambulation and interference with the activities of daily living;
  AND
• Symptoms or functional impairment persists despite significant* weight loss which has been stable for at least 3 months or well-documented attempts at weight loss (medically supervised diet or bariatric surgery) have been unsuccessful; AND
• If the individual has had bariatric surgery, he/she is at least 18 months post operative or has documented stable weight for at least 3 months.

*Significant weight loss varies based on the individual clinical circumstances and may be documented when the individual:

• Reaches a body mass index (BMI) less than or equal to 30 kg/m2; or
• Has documented at least a 100 pound weight loss; or
• Has achieved a weight loss which is 40% or greater of the excess body weight that was present prior to the individual's weight loss program or surgical intervention.

Source: https://anthem.com/medicalpolicies/policies/mp_pw_a053328.htm

Some insurance companies may have different criteria, but the above list is what Anthem needs before agreeing to cover the procedure.

MorganMoreaux

jgnatca wrote: »

@MorganMoreaux , obesity is now identified as a disease. Do we make people pay for their own health coverage because they "inflicted it upon themselves", like smokers with COPD, or the sexually active with vaginal or throat cancer?

For significant weight loss, the excess skin literally hangs and can get in the way of everyday activities. It is also difficult to keep clean and dry so thus can be susceptible to fungus or other infections.

I think the excess skin removal should be covered by insurance- I said as much in the second paragraph. I don't think it should be compared to reconstructive surgery for breast cancer survivors. Regardless of whether it's classified as a disease or not, it is brought about by lifestyle choices where as breast cancer is not lifestyle related, and I don't agree with the comparison.
Also, your response doesn't make much sense as I was referencing the comparison itself. I was not addressing whether or not obesity and related treatments should or shouldn't be covered by insurance, which, if you read the second part of my post, you would know where I stand with that