Denied for Skin Surgery
garber6th
Posts: 1,890 Member
I just found out that my insurance company denied me for skin removal surgery. The plastic surgeon's office said that it's about 50-50 when it comes to approvals for that surgery, but they said that appeals usually turn over the denial, so now I will start the appeal process. Just another part of this process! I will keep everyone posted, because some of you might go through the same thing.
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Do they give any sort of reasoning with the denial? Like not long enough at goal weight, or not enough documented medical issues with the extra skin?
Good luck with the appeal. I'm looking forward to your updates.
-Phill0 -
As a retired nurse I have some experience with insurance companies covering things. It's all about the documentation. You and your family Dr need to work together on documenting skin care. What the insurance company will not do is cosmetic surgery. So if you have any problems like a rash, irritation, sores anything go to the Dr and record it, build up a justification for the skin removal.
Randy RN0 -
Sorry to hear that! I totally agree with Randy, it is all about the paperwork. I just got ok'd a couple of weeks ago and the surgeon that is doing it is know in our area for being a great surgeon but also for having the paperwork down to a T, and pictures of rash etc will definitely help. Last thing, don't give up!! I wish you all the best. Tracy.0
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The surgeon I went to has a lot of experience with WLS patients and he knows what looks good on the paperwork, etc. The insurance company said that there doesn't seem to be any chronic issues as a result of the excess skin. I will work on it!
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Bummer! I trust you will find a way through this minor setback.0
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I hope the appeal goes through quickly for you. We will all think positive thoughts.0
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Temporary setback --- hang in there!0
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Good luck to you. Hope you can have it done.0
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I went to the plastic surgeon and they measured the panus. The insurance documentation was very specific and my panus did not hang below my genitalia. Also according to all the people in my support group you wouldn't want the ins qualified skin removal-because they just chop off the skin-there is no plastic surgery sculpting of an aesthetically appealing result. Vanderbilt quoted me $24,000 cash pay for my arms, belly, thighs and boobs. And it would be aesthetically sculpted as they would be able-I think it a good price0
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The surgeon I am going to is going to do more than just skin removal, he is definitely going to try to make it look good, but he is pricey. I am going to get a second opinion soon too.0
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Good luck! 2 in our group paid for theirs and are very pleased but both said it was the worst pain of their lives0
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I'm a chicken- I'm gonna keep my Grandma Moses body for now, LOL!0
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I agree with the documentation. Anything that shows that there is a medical reason and that it is not just cosmetic: rashes, infections, difficulty exercising which could affect weight maintenance, difficulty getting dressed, lower back pain etc. Good luck. I hope you can get it approved through insurance.0
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Mangopickle wrote: »I'm a chicken- I'm gonna keep my Grandma Moses body for now, LOL!
You and me BOTH. Elective surgery scares me. I don't have the $ anyway, but besides that, my fear is when would it stop? When would I be satisfied-- after the boob job? After the upper body lift? After the butt job? After the lower body lift? Then maybe I would want to do something about the wrinkles at my neck... and face..... and on and on it might go. What a nightmare! No thanks!0 -
besides that, my fear is when would it stop? When would I be satisfied-- after the boob job? After the upper body lift? After the butt job? After the lower body lift? Then maybe I would want to do something about the wrinkles at my neck... and face..... and on and on it might go. What a nightmare! No thanks!
^^^^This!!
I'm still at least 6 months to goal. I know I won't be "aesthetically pleasing" with all the hanging skin, but have heard it is a painful procedure with potentially difficult recovery, and when would I be satisfied??0 -
I was just seen for my 1 year post op appt by the Nurse Practitioner with my bariatric program. She offered me a referral to a plastic surgeon and I told her no way. I have heard of people having it done here.I am in Canada and they will pay for a Panniculectomy (apron removal) but its not great and people have been turned away from having it done for the skin not hanging over their genitals. Mine so far does not hang over so I wouldn't be covered anyway. I could get a breast reduction but its only a reduction no lift or anything. So why bother? My hubby don't care about the skin and I am not putting myself through anymore elective surgeries if I can help it.0
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The surgeon I am going to is going to do more than just skin removal, he is definitely going to try to make it look good, but he is pricey. I am going to get a second opinion soon too.
And I want to add--- for you and other folks who elect to have surgery, I say GOOD ON YA! And I wish you well-- I did not mean to not be supportive by saying it is not something I would choose. Everyone is different and we all know best for ourselves.
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I'm one big chicken too, but I also don't have the money. I'm still extremely glad that I had the Sleeve.0
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My bariatric team recommends no surgery until at least 5 years AFTER surgery if you are following the protein and exercise guidelines. I'm 46 and hoping that at the end of this journey to have lost a little over 200 lbs. By year 5, I should know what sags are permanent, which sags I can improve with exercise, and I bet which ones I can live with. Don't rush it - if insurance didn't approve it - wait. I bet even without the surgery you look amazingly different and healthier.0
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