i have an HMO that states they will cover any procedure an MD requests. that is how i got my lap band paid in full with a BMI of 35.so I have wanted to remove the excess skin around my belly , b/c I am pretty small under all the skin and have to wear spanx to fit in to clothes. so I called the PCP and got the referral to the PS office and called the PS this am and the receptionist said "Oh no one ever gets there TT covered. Even when your insurance says they cover it we will not submit unless you have skin hanging below your pubic hair." so now I am sad, cause I dont think the skin hangs that low. Can anyone give me some advice or help on how to handle this?? thanks. love to hear everyones stories too

i think you must not have understood my post, I am not seeking major abdominal surgery to look cute in a bathing suit. I have huge amounts of abd flesh, that hangs off my small frame that I have to actually pick up and move when I sit down, get sore red skin i don't wear a strong girdle to hold it up and clearly looks like a disfigurment. I will stay positive and keep hope alive that I will get coverage for my panniculectomy.

Cosmetic surgery is usually not covered under any insurance regardless of what you MD refers you for. Because it is just that for cosmetic reasons. If anyone got their insuance to pay for it was because they had really bad medical issues with it. I doubt if your insurance will pay for a tummy tuck.

i think you must not have understood my post, I am not seeking major abdominal surgery to look cute in a bathing suit. I have huge amounts of abd flesh, that hangs off my small frame that I have to actually pick up and move when I sit down, get sore red skin i don't wear a strong girdle to hold it up and clearly looks like a disfigurment. I will stay positive and keep hope alive that I will get coverage for my panniculectomy.

I don't think she misunderstood your post. In our eyes, it's not cosmetic, but in the eyes of the insurance companies it is. It is very rare that they cover any type of plastic surgery unless there is a significant medical issue (ie: breast reconstruction after a mastecomy). If you are getting sever rashes, make sure you are going to the doctor for them even if you can treat them at home and make sure you and the doctor document and photograph everything. That is about the only way I have seen it covered is major skin rashes. Even then, they only cover the skin removal and not muscle repair that a full tummy tuck would cover. I wish you the best.

i have an HMO that states they will cover any procedure an MD requests. that is how i got my lap band paid in full with a BMI of 35.so I have wanted to remove the excess skin around my belly , b/c I am pretty small under all the skin and have to wear spanx to fit in to clothes. so I called the PCP and got the referral to the PS office and called the PS this am and the receptionist said "Oh no one ever gets there TT covered. Even when your insurance says they cover it we will not submit unless you have skin hanging below your pubic hair." so now I am sad, cause I dont think the skin hangs that low. Can anyone give me some advice or help on how to handle this?? thanks. love to hear everyones stories too

Hi:

I recommend that you find a plastic surgeon that has dealt with alot of patients with weight loss surgery. If you look at www.makemeheal.com you may be able to find somebody in your area that can recommend a surgeon that specializes in plastic surgery for post weight loss surgery patients. Good luck! I got coverage for a panniculectomy but paid for the upgrade to tummy tuck. I'm very happy with the results.

Take care.

Sue

I did not misunderstand your post it is true that most insurance companies will not pay for a tummy tuck because it is cosmetic. You can live with hanging skin unless it becomes a medical problem which most of the time it doesnt. Even if it is covering your pubic space and is not causing you medical problems most insurance companies will not pay for a tummy tuck and that is fact. The only way they will pay for a panniculectomy is if you have ulcers that wont heal, skin rashes that wont go away with any type of treat ment and if it interferes with you activites of daily living such as not being able to get out of bed, tie your shoes, or walk, then it may be hard to get approved because you must have many documented months of health issues due to hanging skin.

I disagree. My rashes were pink, and came back a few times, but I did not have ulcers. Go to a doctor that deals with post WLS patients and you'll have a better chance of getting any insurance coverage. Insurances vary so much.

Best wishes to you.

Sue

I had the panni done and insurance did pay for it. My skin wasn't too bad but I did have rashes from time to time. My bariatrics surgeon wrote a wonderful letter for my plastic surgeon to send in along with photo's to the insurance company about why I needed to have the surgery. You know it would be worth the effort to go to the plastic surgeon for an evaluation and then they tell you what they will need from you....mine asked for a letter from my bariatrics surgeon. The worst that could happen is you will be out the co payment to the plastic surgeon should your insurance deny you but you'll never know for sure if you don't give it a try. And just for the record the panni was a great choice for me, my tummy is flat and I have a cute belly button. The other thing which is great is that the surgery is much less painful than a tummy tuck, really I had zero pain which even surprised me. Now, I did have a breast lift done at the same time (still pain free) but I did have to pay for that. It was worth it .

wow, what great advice. thanks so much for all the positive feedback. if I had listened to all the "nay sayers" when I was looking into my LB 2 years ago Ide still be sitting here completely miserable @ 80lbs overweight. I know that cosmetic TT is very rarely covered. but I guess I may have a very good HMO plan cause when I called to inquire they said it was covered after large wt loss. went to the MD today for a letter and referral to have a pann/tt done and he was more than happy to give it. he kept complimenting me on my hard work. I will now go see my LB surgeon who also does panni's and tummy tucks. he told me last year that he only does them after 1 year and when you are within 10lbs of your goal. so I need to lose 10lbs. QUICK!! I have done some more research and found out alot of PS don't like to do TT's for insurance cause they don't get the $$$$ like when paying cash. So i guess we will jus have to wait and see. this is important to me, but I always try and remember that there are so many people out there that have alot more serious medical problems than I do, I am lucky to have what I have.

I had the panni done and insurance did pay for it. My skin wasn't too bad but I did have rashes from time to time. My bariatrics surgeon wrote a wonderful letter for my plastic surgeon to send in along with photo's to the insurance company about why I needed to have the surgery. You know it would be worth the effort to go to the plastic surgeon for an evaluation and then they tell you what they will need from you....mine asked for a letter from my bariatrics surgeon. The worst that could happen is you will be out the co payment to the plastic surgeon should your insurance deny you but you'll never know for sure if you don't give it a try. And just for the record the panni was a great choice for me, my tummy is flat and I have a cute belly button. The other thing which is great is that the surgery is much less painful than a tummy tuck, really I had zero pain which even surprised me. Now, I did have a breast lift done at the same time (still pain free) but I did have to pay for that. It was worth it .

My insurance just approved me for a TT with my LB surgeon. We submitted pics of my hanging flab. Getting mine done July 13ish

My insurance paid for my TT w/MR. DON'T give up, I went to 5 different consults and the only doc that was willing to submit the paperwork was the first person I saw and the surgeon my LB doc recommended. I love my PS and am glad he was willing to take my insurance. Everyone else I saw said that insurance wouldn't cover the procedure - I assured them they did as I did lots of homework and spoke with the reps on a regular basis to make certain that I covered all bases.

As a previous poster noted, most plastic surgeons don't want to take the reduced fees paid by the insurance and want you to pay in cash or finance the procedure through the many medical finance companies.

good info from everyone...thanks!