Insurance for excess skin

JVClubs
JVClubs Posts: 139 Member
in Health and Weight Loss
Sadly. My weight hasn't buged much in 2015. Mostly my fault but I had gotten serious chest spasms which kept me out of the gym for a number of months.

Me weight usually sits between 315-285. I am 6'5". I've lost a lot. Was 562 in 2013.
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I'm thinking about getting my chest and stomach done. My arms I dont mind, my legs are ok. I've been at this weight like almost a year now. Its stabilize. And I'm curious to see what I'd look like with this extra skin gone.

I live in Illinois. Its open enrollment for a lot of health insurances and I like to know what would be the best insurance to go thru so I dont have to pay 25k or more to get this procedure done. I'm very nervous and scared of doctors offices but this is something I want done. I just wanna look like s normal guy. Any suggestions I'm very open too. Thanks agsin.
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Replies

  • DeguelloTex
    DeguelloTex Posts: 6,652 Member
    The only things I can suggest are 1) talk to a doctor about it and 2) maybe get closer to goal weight (unless you're already there) before doing it, but that might be countermanded by what happens with 1).
  • wkwebby
    wkwebby Posts: 807 Member
    I do not believe the excess skin surgery will be covered by an insurance company unless you get a doctor to sign off saying that it is medically necessary. Otherwise, without the "doctor's note/rx", any insurance would chalk this type of surgery up to being cosmetic and it won't be covered. Really ask some of these questions to any insurance company that you think about going with.
  • jemhh
    jemhh Posts: 14,261 Member
    I would not get this done at this point. Unless you are very muscled, you are still not at your goal weight. Additionally, it takes a couple of years for your skin to shrink up as much as it is going too. Yes, you are going to have excess skin but you don't know how much at this point. It makes more sense to work on your health issues (chest spasms) and get to your goal weight before undertaking a major surgery like this.
  • SoDamnHungry
    SoDamnHungry Posts: 6,998 Member
    Do you plan to lose more bodyfat? If so, I would hold off on the skin surgery since you'll likely develop more loose skin. Give it time to shrink naturally and lose everything you want to, then get the surgery.
  • amyk0202
    amyk0202 Posts: 666 Member
    Good job on your loss! Unless the extra skin is causing you significant physical issues, like rashes that won't go away and are getting infected, it is unlikely that you will find any insurance company that will pay for your surgery. They consider it cosmetic. I went and saw 7 different surgeons & got estimates & then decided what was most important to me & started there.
  • JVClubs
    JVClubs Posts: 139 Member
    Lol I've always wanted to be nearly bone thin, but I get a lot of suggestions that say, stay at 240-260. My original goal was 275. I've came really close but then I got sick. I'm better now but I do want to get rid of it. It looks awful now, even though I guess its a huge improvement from before =\.

    Ii dont really get sores, but it is an inconvenience to wash in the shower now and then. I'm really an extra large to 2XL but with the skin it kinda does hang a bit so I'm a 2X-3XLT
  • TheSatinPumpkin
    TheSatinPumpkin Posts: 948 Member
    edited November 2015
    i see mine as well deserved battle scars on a war i am winning.
  • beemerphile1
    beemerphile1 Posts: 1,710 Member
    Unless your doctor can convince them the skin removal is necessary medically, no insurance company will cover it cosmetically.
  • jgnatca
    jgnatca Posts: 14,464 Member
    Excess skin after significant weight loss is a common problem. I often point to this video to illustrate.

    https://www.youtube.com/watch?v=CpKDteQ3FIQ

    Here in Canada under public health care, some skin removal is typically covered, as the excess folds of skin can be difficult to keep clean. Believe me, our public insurance group is very conservative about things like that. I have seen cases even in the United States where insurers have covered this sort of skin removal. I'm sorry I can't give any experience on which insurer would be better. I think you would have to investigate each one.
  • Kalikel
    Kalikel Posts: 9,603 Member
    Wait until you're done losing. How much would it suck to go through all the trouble of surgery only to lose more weight and end up with loose skin?! It would suck a lot. Wait until you're done. Then get it all removed, if you want.
  • jemhh
    jemhh Posts: 14,261 Member
    I just want to be clear that I don't think there is anything at all wrong with wanting to have the excess skin removed. I will likely have some, though to a lesser degree, and if I could be rid of it I absolutely would. I just think it would be better to wait until you are at your final goal, which it doesn't seem like you are. You have come a long way, a really long way, and that is absolutely fantastic. I'm sure it's hard at this point to be so much closer to being *there* but still have the skin issues. I'm at the point of utter impatience with wanting to see the "final" me and I haven't had to put in as much work as you have. Good work, OP :)
  • JVClubs
    JVClubs Posts: 139 Member
    jemhh wrote: »
    I just want to be clear that I don't think there is anything at all wrong with wanting to have the excess skin removed. I will likely have some, though to a lesser degree, and if I could be rid of it I absolutely would. I just think it would be better to wait until you are at your final goal, which it doesn't seem like you are. You have come a long way, a really long way, and that is absolutely fantastic. I'm sure it's hard at this point to be so much closer to being *there* but still have the skin issues. I'm at the point of utter impatience with wanting to see the "final" me and I haven't had to put in as much work as you have. Good work, OP :)


    Thanks man I appreciate it. I'm honestly burnt out. I can't seem to get under 280 but I'm trying my best. I do like to lose more but its tough to stay discipline.

  • hekla90
    hekla90 Posts: 595 Member
    edited November 2015
    If you can't get and maintain a healthy bmi in the first place, and you aren't having medical issues it's probably not going to be covered (and shouldn't, it's a cosmetic procedure. I don't expect anyone to pay for new boobs that I want!). You are still well in an obese bmi I can't see this being covered for you.
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  • jgnatca
    jgnatca Posts: 14,464 Member
    Canadians can get breast reduction surgery, as it can become a back issue. There is a cosmetic component but there's also the person's quality of life. My girlfriend survived breast cancer (stage three) fifteen years ago. She qualified for cosmetic repair last year and the surgeon reduced her surviving breast and reconstructed the other. Very soon after surgery, nagging back problems went away. Was this cosmetic or medically necessary?
  • VykkDraygoVPR
    VykkDraygoVPR Posts: 465 Member
    JVClubs wrote: »
    jemhh wrote: »
    I just want to be clear that I don't think there is anything at all wrong with wanting to have the excess skin removed. I will likely have some, though to a lesser degree, and if I could be rid of it I absolutely would. I just think it would be better to wait until you are at your final goal, which it doesn't seem like you are. You have come a long way, a really long way, and that is absolutely fantastic. I'm sure it's hard at this point to be so much closer to being *there* but still have the skin issues. I'm at the point of utter impatience with wanting to see the "final" me and I haven't had to put in as much work as you have. Good work, OP :)


    Thanks man I appreciate it. I'm honestly burnt out. I can't seem to get under 280 but I'm trying my best. I do like to lose more but its tough to stay discipline.

    It's tough, but you can do it. What are your goals set at? You don't need to exercise to lose, just eat fewer calories than you expend. So, with that in mind, maybe just set a shallow loss goal. Say a 250-500 calorie deficit. Just make sure to weigh your food on a scale and it gets easier.

    I'm 6'3" (or 4, not sure), and I'm tipping in at about 243 right now. I'll tell you what, being able to walk into the mall and buy well fitting clothes from any store is well worth the struggle. :)
  • kami3006
    kami3006 Posts: 4,979 Member
    jgnatca wrote: »
    Canadians can get breast reduction surgery, as it can become a back issue. There is a cosmetic component but there's also the person's quality of life. My girlfriend survived breast cancer (stage three) fifteen years ago. She qualified for cosmetic repair last year and the surgeon reduced her surviving breast and reconstructed the other. Very soon after surgery, nagging back problems went away. Was this cosmetic or medically necessary?

    I had a reduction due to back pain and general discomfort and it was fully covered by my insurance here in the US. If there is any discomfort, even minor, it's usually considered medical necessity. Of course I am thrilled with the cosmetic aspect if it.
  • cdcllcga01
    cdcllcga01 Posts: 71 Member
    First off - congratulations on the significant accomplishment you've achieved. 260+ in a couple of years is a significant accomplishment that proves "you got it". I agree that unless the excess skin is causing infections, etc. it will probably not be deemed medically necessary and thus not be covered under insurance. As hard as it would be, I would also support the advice others have given to get to your ultimate goal weight and maintain there for a period of time that will allow your skin to shrink as much as it will before getting any procedure done. I think you should pick the weight that you think is healthy and right for you vs. what others say.

    Skin removal surgery is a very significant procedure and you want to minimize any work to be done. You can research several case studies at realself.com to see how significant the procedures are. Get advice from a few surgeons as well before making a final call.

    Good luck! You've accomplished an extremely significant achievement already - the sky is the limit for you.
  • tomatoey
    tomatoey Posts: 5,446 Member
    Amazing work :)

    I'm not the US so can't speak to the insurance issue, but I wonder whether if you saw a doc now, and developed a relationship with them through your continuing weight loss, you might have an ally down the line...

    I also think saving money now for any procedure/s you might choose to do would a good idea. I don't know if you can get to 25 000 in two years, but maybe you can get part of the way, and get some advice on investing it somehow? Maybe that could be part of your motivation... (In addition to lack of familiarity with US healthcare & insurance, I have no idea about financial planning :/ so can't help with that.)

    I've seen a few people post about this issue. It's a shame there isn't more help available for this. It would be great if the kinds of incredible lifestyle changes you've already made were rewarded. You're saving your health care system money down the line :/ It's probably about the same cost as weight loss surgery :/

    Agree that the chest spasms need to be looked asap if they haven't been, though. Don't ignore that.

  • mccindy72
    mccindy72 Posts: 7,001 Member
    You've done a wonderful job, losing so much weight and coming so far. But you're so close to getting all the way there! Don't stop now. Just give it more time, stick with the work. Once you get to goal weight, you'll need to maintain, because if you do have the surgery to repair your skin, you don't want to gain weight and stretch it out again. You want to be sure that the maintenance is so much a part of your routine that it's just what you do.

    As far as the surgery itself, most plastic surgeons will give you information about CareCredit, which is a company that finances cosmetic surgery. So you don't have to come up with all of the money, but if you have some saved up, it will definitely help. Work on that while you're losing the rest of the weight.
  • hekla90
    hekla90 Posts: 595 Member
    jgnatca wrote: »
    Canadians can get breast reduction surgery, as it can become a back issue. There is a cosmetic component but there's also the person's quality of life. My girlfriend survived breast cancer (stage three) fifteen years ago. She qualified for cosmetic repair last year and the surgeon reduced her surviving breast and reconstructed the other. Very soon after surgery, nagging back problems went away. Was this cosmetic or medically necessary?

    So can those in the US. It is covered by insurance. Getting breast implants after a mastectomy is not medically necessary, it is absolutely cosmetic. It is generally covered by insurance here as well. Medically necessary means you will suffer some type of physical consequence if it's not done. I find that crazy it took 15 years to get that approved. Definitely would not have taken anywhere near that time to get approved and completed here.

    While cosmetic I view that as no different than if someone was in a car accident and needed facial reconstruction. There's nothing wrong with my tatas, just smaller after losing weight my insurance shouldn't have to pay for that for instance.

  • xxxibgdrgn1981
    xxxibgdrgn1981 Posts: 10 Member
    From your pic u look amazing !!!!!!!!!!!!!!!!!
  • mccindy72
    mccindy72 Posts: 7,001 Member
    hekla90 wrote: »
    jgnatca wrote: »
    Canadians can get breast reduction surgery, as it can become a back issue. There is a cosmetic component but there's also the person's quality of life. My girlfriend survived breast cancer (stage three) fifteen years ago. She qualified for cosmetic repair last year and the surgeon reduced her surviving breast and reconstructed the other. Very soon after surgery, nagging back problems went away. Was this cosmetic or medically necessary?

    So can those in the US. It is covered by insurance. Getting breast implants after a mastectomy is not medically necessary, it is absolutely cosmetic. It is generally covered by insurance here as well. Medically necessary means you will suffer some type of physical consequence if it's not done. I find that crazy it took 15 years to get that approved. Definitely would not have taken anywhere near that time to get approved and completed here.

    While cosmetic I view that as no different than if someone was in a car accident and needed facial reconstruction. There's nothing wrong with my tatas, just smaller after losing weight my insurance shouldn't have to pay for that for instance.

    Actually the qualification was changed a few years ago, so that the reconstruction after mastectomy is considered part of the coverage. There was some litigation I believe, but it was proven that the emotional scarring the women suffered after going through not only facing cancer, but also suffering the loss of one or both both breasts, made the procedure medically necessary.
  • jgnatca
    jgnatca Posts: 14,464 Member
    I might point out that there might have been more than one factor in place for the fifteen year wait. First of all she needed a clean bill of health. Second, she lost significant weight before going for surgery. And finally I don't know how long it took her to make up her mind.

    The rebalancing of her breasts cured her of chronic back pain. That's more than cosmetic.
  • Hearts_2015
    Hearts_2015 Posts: 12,031 Member
    edited November 2015
    jgnatca wrote: »
    Excess skin after significant weight loss is a common problem. I often point to this video to illustrate.

    https://www.youtube.com/watch?v=CpKDteQ3FIQ

    Here in Canada under public health care, some skin removal is typically covered, as the excess folds of skin can be difficult to keep clean. Believe me, our public insurance group is very conservative about things like that. I have seen cases even in the United States where insurers have covered this sort of skin removal. I'm sorry I can't give any experience on which insurer would be better. I think you would have to investigate each one.

    Youtube vid is wonderful....what a cool guy :) He's very inspiring! OH, I hadn't realized He was a member here on MFP
  • vczK2t
    vczK2t Posts: 309 Member
    i work in the health insurance industry, for a health insurance company. I can assure you that most, if not all, insurance companies AREN'T going to cover cosmetic surgery. that's what you are describing, is removing excess skin to look better. you need to call the insurance companies to find out if surgery to remove excess skin is covered or not. NOBODY on MFP works or knows the ins and outs of ALL insurance companies. do your homework and find out which insurance policy works best for you.
  • vczK2t
    vczK2t Posts: 309 Member
    edited November 2015
    hekla90, "Medically necessary means you will suffer some type of physical consequence if it's not done." that is NOT the meaning of medically necessary. medically necessary means "...would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, disease, or its symptoms....." and those criteria have to fall in the insurance company's guidelines, not the doctor's.

    also, breast implants after a mastectomy are not "cosmetic". it is reconstructive surgery. THAT'S why most insurances cover it.
  • MorganMoreaux
    MorganMoreaux Posts: 691 Member
    Am I the only one slightly offended by the mention of insurance paying breast implants for cancer survivors is even being compared for lose skin removal because someone lost weight? I'm not trying to be mean, but these are two completely different things. Whereas obesity and thus the need to lose weight resulting in lose skin is completely preventable, breast cancer is not related to lifestyle choices that the person inflicted on themselves, and has great physical and psychological ramifications. I honestly find the comparison gross.

    That being said, kudos OP for all the hard work. It is unfortunate that insurance will not cover those procedures, because it definitely affects quality of life. I feel that insurance companies in the United States are way to profit driven, to the detriment of the American people. I won't get started on the pharmaceutical industry. OP. - I don't know your financial situation, but if at all possible try to find a doctor that will advocate for you. They may be able to present the necessity of this procedure to the insurance company where they will cover it. I haven't had to "fight" for any large procedure, but I frequently do so for smaller tests etc that I want done. I have a wonderful doctor that guides me in what I should say so that the tests are covered. Try to find people online who have had this procedure covered by insurance and find out what they did/said. Personally, I think the day to do inconvenience of the lose skin along with the psychological components of having it should be sufficient, but that's neither here nor there.

    Good luck!
  • jgnatca
    jgnatca Posts: 14,464 Member
    Hearts_2015 wrote: »
    jgnatca wrote: »
    Excess skin after significant weight loss is a common problem. I often point to this video to illustrate.

    https://www.youtube.com/watch?v=CpKDteQ3FIQ

    Here in Canada under public health care, some skin removal is typically covered, as the excess folds of skin can be difficult to keep clean. Believe me, our public insurance group is very conservative about things like that. I have seen cases even in the United States where insurers have covered this sort of skin removal. I'm sorry I can't give any experience on which insurer would be better. I think you would have to investigate each one.

    Youtube vid is wonderful....what a cool guy :) He's very inspiring! OH, I hadn't realized He was a member here on MFP

    He is???? How COOL is that! Shout out, young man, I love your videos!
  • jgnatca
    jgnatca Posts: 14,464 Member
    @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.

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