UPDATE......

I spoke with a Representive from UHC and Yes Breast lift and thigh lift are a covered procedure. (However brachioplasty is not) When accompanied by documentation. So Now to schedule an appointment. Not before I have another visit with my PCP to check in and have more documentation. (More is sometimes better) Then we will see where this goes. I may have to seek several opinions, don't want to be tied to just one. If anyone has UHC and has any addtional info please share.

Just wanted to share what I have found out.

Thanks,

Deb.

Wow, really? Do you know if they also cover tummy tucks? I also have UHC, and that is something I definitely want to check into.

Hi wishes. I will have an answer for you today. The tt would be without muscle repair. (Which is what I have a CPT code for.)

Deb.

Hey, I remembered reading a post by LoquaciousLaura about getting plastic surgery after WLS, and I called about the CPT codes:

1. Mastoplexy (breast lift): CPT code - 19316

2. Brachioplasty (arm lift): CPT code - 15836

3. Pannulectomy (tummy tuck w/ muscle reconstruction): CPT code - 15830

4. Thigh lift: CPT code - 15823

I spoke with a UHC Choice Plus representative today, and she said that each of these procedures "could" be covered with a pre-determination from insurance, even the brachioplasty but each has the potential to be cosmetic so they would need the information from my PCP or surgeon why it is medically necessary.

My company is switching over to UHC from Aetna. Good to know. Thanks for looking into this guys!

What kind of documentation is needed for these surgeries to be covered?

Also, I heard on the breast lift...the insurance company requires you to reduce to a "B" cup. Any one know if this is true? (I have been a "F" cup all of my adult life and it would look really weird for me to be a "B" cup)

Wow, thanks for this great post. I have UHC, and I didn't realize that I had any options for plastic surgery! If there is any more info out there, please post it. Thanks again.

I have UHC also and looked into it after I was successfull with my band- All of what I was looking for was covered with documentatioin. I had 2 consults both of which would NOT file insurance although I was given the option to file a claim on my own for reimbursement. I obviously have opted not to have anything done yet and am being sleeved in 48 hours. My current doctor has a plastic surgeon that not only takes insurance, takes payments but also assists with financing if needed- I am going to look into this next year as I still have more weight to loose...

"UHC covers plastics" is sort of misleading. I have UHC Choice Plus, as well as I work for a large hospital that is also a Center for Bariatric Excellence.

Major medical health insurance, by it's very definition will only cover medical procedures and/or treatment that is medically necessary, and when you use CPT codes and ask if it is covered the representative that you are speaking with is only referencing the code and your plan type to see if that is a covered benefit. The caveat is that being told something is "covered" is not a guarantee of payment. Payment of a claim can only be determined at the time said claim is received. At that point they are looking at surgeon's notes, diagnosis, etc.

I cannot tell you how many patients have had procedures at our facility and later received a large bill because their insurance told them something was "covered".

With that being said, UHC does not cover "plastic surgery" because plastic surgery is not medically necessary and is done for cosmetic purposes only BUT certain plastics can become medically necessary and after WLS the typical surgeries that patients want their insurance to cover are panniculectomy which really is not the same as the cosmetic tummy tuck (abdominoplasty). A panniculectomy will only remove excessive skin below the belly button, which is basically the "pouch" that hangs on your pubic area and is a purely functional surgery. The abdominoplasty removes the skin AND tightens the abdominal muscles and often involves "contouring" of the abdomen to give that area a more aesthetic appeal. Again, purely cosmetic and has no medical implications at all. No insurance will cover abdominoplasty.

Also the guidelines under which an insurance company will cover panniculectomy, breast lifts, thigh lifts, etc ... are pretty much the same. The patient has to have experienced recurrent tissue/skin infections as a result to massive weight loss and excess skin. The type of insurance you have, and your employer benefits will determine if this is covered, and if covered how long you have been affected with skin infections, but almost all want to see chronic infections that have been treated with multiple courses of oral medications (most common tetracycline) - they want to see continued use w/ no improvement.

Lastly, do not make the common mistake of thinking because it's UHC that all insurance plans are the same! They are not. There are SO many different plan types, exclusions, etc. Since UHC does not offer individual policies and group only it is impossible to compare plans to a friend, etc. Your employer will determine ultimately what your plan benefits are. They purchase policies from insurance companies that are packaged and what your friend's UHC policy covered may not necessarily be covered by your own policy.

Hope this helps.

TAI29 - Excellent advise - also each employers plan can also have different exclusions if they are self-funded large employer group. I am in the insurance industry - and know self-funded large employer groups can "pcik and chose" what they want to cover when it comes to "non-essential health benefits" -

Thanks Tai! That is a great explanation of how difficult this process is, that this is for those with excess skin issues after WLS, and that insurance plans are not the same even though they have the same name. Great post!

Thank you Kimmes ... you are absolutely right about plans picking and choosing. Sometimes I review a patient's benefits and think their HR people are real _____ holes ... I never cease to be amazed at what insurance companies can weasel out of adding saying it's not an "essential health benefit"

Wishes ... I am happy I could help. I felt like I was rambling on a bit, but I also would hate for anyone to have the burden of huge medical bills to pay because they were under the impression something was "covered" and it really is not. Insurance jargon can be like a foreign language or double talk because it is "covered" but deemed not medically necessary so therefore DENIED! lol ... Patient's need a translator and that is where I come in!

After WLS the last thing a patient should have to worry about is financial burden of paying medical bills. Personally speaking, I want to save all my money for skinny jeans! :whoo:

Excellent post Tai29! I have not yet looked into plastics (I do have UHC) but I am 100% grateful that my husband's employers INCLUDED WLS as a covered benefit. When I told my Nurse Case Manager "thank you" she directed the thanks back to his employer. We have a high-deductible plan and we were both sleeved in two different years (me 2010, him 2011) so we have had to pay about $8K out of pocket (the remaining $2K came from his employer...the amount they tossed into our plan {$1K each year} at the beginning of each calendar year) but it was worth every penny and I was so happy to not be SELF-PAY.

Haven't done a stitch of research on plastics yet...need to get to goal and maintain a while before figuring that all out.

I have gained much info about UHC, Thanks