Should insurance pay for cosmetic surgery after weight loss
debloves2ride
Posts: 386
This topic came up when I posted this link: http://gma.yahoo.com/video/health-26594251/extreme-weight-loss-woman-loses-282-pounds-27563061.html#crsl=%2Fvideo%2Fhealth-26594251%2Fextreme-weight-loss-woman-loses-282-pounds-27563061.html
A young woman lost over 251 lbs, she weighed over 500 lbs. Her goal is is to loose another 150. the big issue after the weight loss is the excess skin. Should insurance cover the cost of the removal/lift?
I think they should - the weight loss is dramatic and is avoiding so many other health issues that the insurance company would be paying for. They would have less cost paying for the skin fix than the heart, circulatory, high blood pressure etc... issues.
A young woman lost over 251 lbs, she weighed over 500 lbs. Her goal is is to loose another 150. the big issue after the weight loss is the excess skin. Should insurance cover the cost of the removal/lift?
I think they should - the weight loss is dramatic and is avoiding so many other health issues that the insurance company would be paying for. They would have less cost paying for the skin fix than the heart, circulatory, high blood pressure etc... issues.
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Something like that should be deemed medically necessary. A boob lift to put the girls back where they belong is a different category.0
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I think they should,it should be considered a reward for hard work. And as someone said before they are saving money in the long term.0
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Nope.0
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If it's medically necessary, yes. If it's just for cosmetic purposes, no.0
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Actually it's a crapshoot. It's entirely possible that if that gal hadn't lost the weight she would'a been healthy as a horse 'til she had a massive coronary and expired on her couch. Total cost to Aetna: $400 for the ambulance ride - $250 for a doc to sign the certificate.<<snip>>
I think they should - the weight loss is dramatic and is avoiding so many other health issues that the insurance company would be paying for. They would have less cost paying for the skin fix than the heart, circulatory, high blood pressure etc... issues.
That kind of large scale plastic work costs serious $. Is it worth $250K? How about $100K? $500K?
I gotta agree with Pat. If she needs it to keep healthy then ya',,, if she wants it to look better in the mirror then she can pay for it herself. And this is coming from a guy who really (REALLY!) hates the health insurance "industry".0 -
I'm not entirely sure where I stand on this one. It's not really a health issue per se. More cosmetic. But I hate insurance companies being unwilling to pay for things while they take money from us every single month.
Mostly I'd just like some kind of healthcare reform that brings down the cost of such a procedure. It's not the kind of thing that should cost tens, much less hundreds, of thousands of dollars. I've seen the procedure done. They basically go at you with a hacksaw and then stitch you back up. Whatever is inflating the cost is what needs to be fixed first and foremost.0 -
Not that simple. I'm no doc, but I know a nice lady with no right nipple 'cause Doctor Shouldaretiredfiveyearsago didn't get all the circulation replumbed correctly after her breast reduction. Rightie literally turned black and fell out and left her with a hole in her bewbage.
You can't just "go at it with a hacksaw", you have to make sure you got bloodflow to and from all tissues. Very intricate, very time consuming. And that's surgeon time, in an O.R., with a half dozen support staff standing around and a anesthetist staring at a screen and making adjustments at a higher 'per-minute' charge than renting Soldier Field. Nothing simple, easy or cheap about it.0 -
I don't know. If an insurance plan specifically says "no cosmetic surgery", then I guess not. But if they want to offer it as an incentive for their largest customers to lose weight instead of cash incentives, it's up to them if it's a good business decision. My wife, which is in no way a large person, was able to drop her body fat enough that her insurance provider dropped her payments $40 dollars a month. So if you had some one who needs to lose 250 lbs, then offer the surgery instead of the savings. Either way, I guess it's up to the insurance company. They won't do anything unless their is a profit to be made.0
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Yes. There are medical problems that can occur due to the excess skin, especially if the person has lots of it. Because of the rubbing and the folds, it can cause bacteria, infections, and pain at the location of the excess skin (i.e. excess skin at the lower back can contribute to back pain). I realize the below is a news article but I think it does a decent job of describing some of the issues people have gone through after losing large amounts of weight. One of the points it makes is that depending upon a persons age, the skin doesn't have the elasticity it did during the person's younger years, and therefore may not bounce back or return to the previous state.
http://www.dailymail.co.uk/health/article-2061579/Distressing-skin-problems-The-downside-losing-weight-tells-about.html
Edit to add: I do think it should be an extreme case and one that has been determine to cause further medical issues. If it is solely for cosmetic then no it should not be covered my MEDICAL insurance.0 -
My knee jerk response is that if the insurance company is willing to pay for weight loss surgery, then they should be willing to pay for excess skin removal.
I know not all people who lose a lot of weight and have excess skin did it through surgery, I was just using that as an example.0 -
The question is, where do they draw the line-- how muchw eight lost will qualify you for this? Do you need to demonstrate evidence that the skin is causing medical problems? etc...
I think if the skin is causing major problems, than yes... but if it's solely cosmetic, like you just have some hangy skin under your arms and gut but it's not causing problems... then probably no, because it's no different than any other cosmetic surgery :ohwell:0 -
When your primary doctor, and possibly a second opinion, (neither of whom would be performing the surgery) agree.The question is, where do they draw the line-- how muchw eight lost will qualify you for this? Do you need to demonstrate evidence that the skin is causing medical problems? etc...
I think if the skin is causing major problems, than yes... but if it's solely cosmetic, like you just have some hangy skin under your arms and gut but it's not causing problems... then probably no, because it's no different than any other cosmetic surgery :ohwell:0 -
My mom had the lap band put in and her insurance covered that. I am fairly certain they will cover any surgery for excess skin removal when she's finally at goal weight. But my parents also have the cadillac of insurance (blue cross federal) and they cover EVERYTHING0
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sure why not0
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My mom had the lap band put in and her insurance covered that. I am fairly certain they will cover any surgery for excess skin removal when she's finally at goal weight. But my parents also have the cadillac of insurance (blue cross federal) and they cover EVERYTHING
Blue Cross Federal is THE BEST... my parents have it too, they are both federal employees at a V.A. hospital... I was very sad to be booted off their insurance when I got too old! My current insurance is pretty good, but nothing compared to BCBS Federal! haha0 -
Nope.
Care to elaborate?0 -
I think if someone has an insane amount of hanging skin they should cover it. (maybe at a reduced percentage??)There must be someway to measure it?? It would be sure to cause skin rashes and infections. gross.0
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Not that simple. I'm no doc, but I know a nice lady with no right nipple 'cause Doctor Shouldaretiredfiveyearsago didn't get all the circulation replumbed correctly after her breast reduction. Rightie literally turned black and fell out and left her with a hole in her bewbage.
You can't just "go at it with a hacksaw", you have to make sure you got bloodflow to and from all tissues. Very intricate, very time consuming. And that's surgeon time, in an O.R., with a half dozen support staff standing around and a anesthetist staring at a screen and making adjustments at a higher 'per-minute' charge than renting Soldier Field. Nothing simple, easy or cheap about it.
OMG That is beyond freaky to me. I've had breast enhancement and I always get creeped out about the fact that they take nipples off! I had a good doc though, but there is always the potential, even with a good doc, that this could happen.0 -
Excess skin can lead to rashes and infections in the creases and folds of the skin. I've gotten skin rashes between my thighs from skin rubbing. I can't imagine how bad it would be in someone who has skin rubbing everywhere. I think you could make a good argument about medically necessary skin removal surgery in cases where this is a serious concern.0
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My mom had the lap band put in and her insurance covered that. I am fairly certain they will cover any surgery for excess skin removal when she's finally at goal weight. But my parents also have the cadillac of insurance (blue cross federal) and they cover EVERYTHING
Blue Cross Federal is THE BEST... my parents have it too, they are both federal employees at a V.A. hospital... I was very sad to be booted off their insurance when I got too old! My current insurance is pretty good, but nothing compared to BCBS Federal! haha
Blue Cross Federal is amazing. Hubby and I have that.0 -
It's an interesting question. Certainly if it's medically advisable, insurance should pay for this. I think there's an argument for paying even if it's cosmetic - lots of people decide to lose weight because they can't stand how they look in the mirror, and the low self-esteem that goes with that can be pretty damaging. The potential damage to mental health if excess skin is not surgically removed should also be considered - presumably most insurance plans will cover mental health services, so there is a cost balance to be made.
Also, the disincentive to maintaining the weight loss of STILL hating how you look in the mirror is, I would have thought, quite likely to result in weight regain. If reduced weight = reduced medical risk, then the side effects of the reduced weights should certainly be considered for cover, given the improved risk to the insurer.0 -
If it's medically necessary, yes. If it's just for cosmetic purposes, no.
Agreed. I used to pre-cert medical procedures, based on medical necessity, for a living. Some things honestly are cosmetic but necessary, not so much this one.
And I can't look at it as a reward. The person put themself in the position to stretch their skin that far. Yes they have worked hard to lose weight but it's basically rewarding them for once being fat. We need to focus on reforming insurance so it doesn't cost $200 to go to the doctor. Cosmetic should be self-pay only.0 -
And I can't look at it as a reward. The person put themself in the position to stretch their skin that far. Yes they have worked hard to lose weight but it's basically rewarding them for once being fat. We need to focus on reforming insurance so it doesn't cost $200 to go to the doctor. Cosmetic should be self-pay only.
Am I reading this wrong, or are you saying that covering excess-skin removal surgery would be 'rewarding' that person for one time being fat? (I'm honestly wondering, I might have misread).
That's pretty faulty logic. If insurance is doled out based on merit, then anyone who got hurt by being irresponsible would be denied coverage.
And I'm not sure that skin removal should be classified as 'cosmetic'. Just like insurance covers gastric bypass in cases where obesity interferes with quality of life, they should cover skin removal, which as other posters have mentioned can be painful and cause sores and infection.
There's a difference between getting a nose job and getting skin removed. The former is truly cosmetic; the latter has actual health benefits and can drastically improve quality of life.0 -
And I can't look at it as a reward. The person put themself in the position to stretch their skin that far. Yes they have worked hard to lose weight but it's basically rewarding them for once being fat. We need to focus on reforming insurance so it doesn't cost $200 to go to the doctor. Cosmetic should be self-pay only.
Am I reading this wrong, or are you saying that covering excess-skin removal surgery would be 'rewarding' that person for one time being fat? (I'm honestly wondering, I might have misread).
That's pretty faulty logic. If insurance is doled out based on merit, then anyone who got hurt by being irresponsible would be denied coverage.
Yes, many times insurance doesn't cover things cause by a person's personal deciscions. Most carriers won't cover anything that happens if you are under the influence of drugs or alcohol, self inflicted wounds, and I think that the skin removal should be strictly cosmetic UNLESS medically necessary( rashes, infections, etc.). Like I stated, I worked in medical precertification. I've seen this approved but I've also seen it denied.
I also don't believe in weight loss surgery- thanks to MFP. I've seen so many people here lose hundreds of pounds without it, it seems like a "short-cut" to me. Especially when the patient only covers a fraction. And people wonder why insurance rates are so high...0 -
I think it should. I know some pretty awesome people on here who deserve it.0
This discussion has been closed.