Insurance and TT

[blackcherry2002 5]

Ok so I'm going to see a second plastic surgeon (this one doesn't charge a $50 consult fee ) Anyway, first time my insurance denied me. However I don't think my surgeon then explained much of anything in the letter or whatever to the insurance. Here's the thing...they covered my lapband completely. I went from 270 to 135. I do have a lot of hanging skin, it doesn't look like it because it's being held up pretty well so it just looks like I have a fat belly still basically except that it folds hot dog style on itself as well as rolls? If that makes any sense but yeah it's really loose. And here's the reason for that and the reason I hope my insurance will cover: About 1 to 2 years before my lapband surgery I ballooned from 165 to 270...and I did it in 7 months. I had went to my gyno right before this and had her check my thyroid. She said it was fine. In fact it was 5.6 or something which is NOT in the .3 to 3 or even .5 to 5 range for thyroid. So a year later after my body was streched beyond belief, I went to get a mental health check up for suicidal thoughts. They tested my thyroid again: 22. Also, at the time I told her I thought I had PCOS. She laughed and said no I don't have and she wasn't going to test me for it. Well guess what? Yup have PCOS too.

So basically my question for those of you a little bit more insurance savvy than myself...do you think I could get insurance to cover a TT since it was caused by a medical condition (almost like 'reconstructive surgery')? I do have a tiny rash problem underneath and I keep getting belly button infections on top of it all however I don't have those documented and don't feel like doing such since I'd have to pay for a dr's visit everytime I got a tiny rash, sorry but I'm a college student, it's just not possible (especially since that money goes towards dr's for my thyroid, hormonal and mental health issues).

[June May 2]

I'm going through the same thing. My first Plastic surgeon refused to even request that insurance pay it. My 2nd PS appointment isn't til April 14th. I get belly button rashes too. I have a hernia and have had 4 c-sections, so between the hernia and the "scar revision" I thought a TT would be covered. Now I'm having to do all the leg work.

[Saraboo 21]

I haven't quite reached that point yet. But I would say take pictures of the rashes, print them out, then mail them to yourself. Don't open the envelopes until you need to show the proof. That way the pictures are dated, and show that it's been an ongoing thing,

[Sue Magoo 71]

Hi:

I had a problem with rashes. I showed one of my band doctors and he got all excited and said "that's how you get insurance to cover a tummy tuck". He took pictures. I called my primary care and she recommended a plastic surgeon. I had a rash when I went to her appointment too. My band doctor and my plastic surgeon worked together to submit it to BCBS and I was fortunate to get approval for a panniculectomy, which was considered to be medically necessary. I knew I wouldn't be satisfied with the results, so I asked the plastic surgeon to tell me how much out of pocket it would cost for me to get the full Tummy Tuck. She did some Lipo too and lifted the mons area a bit too. I'm in the Boston area where medical costs are outrageous. The full cost of the tummy tuck was $21k. My cost for the upgrade from panniculectomy to tummy tuck was $7k.

It may take a while, but please take pictures and go and see your doctor when you have a rash. It may save you alot of $$$.

Good luck!

Sue

[blackcherry2002 5]

How bad were your rashes? Mine are more uncomfortable and the skin gets chafed off a bit. And during the summer it gets very sweaty under the folds and in my belly button. I guess now I'm being punished for being obsessive about making sure the area's clean though because they don't really show up on camera. Will the insurance company accept pictures that I've taken myself?

And of course I pretty much avoid physical activity between my stomach and my chest because though they don't look like it, they are very heavy. About 2 weeks ago my back was so bad I was in tears lying on the ground unable to move for about 2 or 3 hours. Not how I want to be at 21 already. These, though a lot of them, seem like mild issues. Then again my mother asked to drive herself to the hospital during a heart attack so I come from a family that doesn't make a big deal unless you are bleeding or dying...

[Sue Magoo 71]

Hi:

My rashes were very red and visible in pictures that both of my doctors took. It was a little bit swollen too. It really hurt and itched. The rashes weren't because of the area being dirty it was because of the folds rubbing against the skin underneath the fold. It was just raw from the chafing.

Hopefully you will get some insurance coverage. Have you already called your insurance company to see what their requirements are?

Sue

[June May 2]

Someone else on here recommended that you take pictures of them yourself and mail them to yourself. Don't open the letter just send it to the insurance, and the post date is proof of when you had the rash. Normally I put deoderant under my boobs and stomach to prevent the rash. Now, I won't bother, but get them documented instead.

[blackcherry2002 5]

My insurance has their covered services online. I have Tricare. They covered my lapband 100% so I'm hoping they will be helpful. Basically they will cover anything for a medical necessity. Basically they same the same about just as long as there are rashes. I'm hoping that my plastic surgeon will also work with me and put absolutely everything in there before sending it. The other one I saw sent pictures that didn't even really show any issues and put nothing else in there. I have the hardest time with getting doctors to make a big deal about anything (not just my plastic surgeons)...I wonder if it has anything to do with the region I live in

[blackcherry2002 5]

Well, it's been awhile since I posted, almost a year but I've caved and I'm getting the surgery no matter what. I'm getting a loan to pay for it if insurance doesn't cover. However, called my lap band nurse today and told her about my other issue: my port is very visible. As in, while wearing shirts, you can see a 1/2 to 1 inch bump sticking out. Her first question was, "Does it stick out when you lay down?" When I told her it was visible upright she was in shock and asked about the tubing. Well, if I have a big meal, I can almost wrap my fingers around the tube. So she said I'll basically definitely get covered for a port revision and I hope to get a Tummy Tuck at the same time. They don't have low-profile ports, so they are going to be sewing the port UNDER my muscle this time. Also, still going to try to get insurance to cover for "reconstructive" due to scars and skin left over from a DISEASE, but either way, I need this stomach gone. I've also lost more weight have gone now from 270 to 120. I was at 116 for awhile too but then Christmas happened I'm getting really excited and I'm already antsy. (I made the appointment for the consult TODAY!) March 19th. We'll see how things go. And hopefully insurance moves quickly.

How quickly did you guys get denied or approved by your insurance?