I was so happy when I found out insurance approved my body lift ad a medical procedure (not cosmetic). See, I suffer from skin rashes, boils and irritation. Both in the folds in my stomach and also under my butt cheeks. I have the scars to prove them. After submitting all my records they approved me.... GREAT NEWS! I cried tears of joy when I got approved.

But that's where it ended.
Every surgeon requires cash payment up front, no big deal. But what is a big deal is the MINIMAL about insurance pays for this procedure. The cash price of $22,000 (some places as low as $19,000) is expensive. Insurance only allows around $3,000 for the entire procedure! IT'S A JOKE. Deductible and max out of pockets, essentially, don't matter because you pay cash up front and only get reimbursement what insurance pays.

I have medical insurance.
This is a medical issue.
Why am I paying still $19,000 out of pocket?

Broken hearted.

Insurance sucks. I'm working through an issue with them myself on my surgery and I know when it's all said and finished that I'm likely going to have to pay more than the self-pay price even though I hit my deductible and OOP max!

58 minutes ago, damzelindistres5 said:

I was so happy when I found out insurance approved my body lift ad a medical procedure (not cosmetic). See, I suffer from skin rashes, boils and irritation. Both in the folds in my stomach and also under my butt cheeks. I have the scars to prove them. After submitting all my records they approved me.... GREAT NEWS! I cried tears of joy when I got approved.

But that's where it ended.
Every surgeon requires cash payment up front, no big deal. But what is a big deal is the MINIMAL about insurance pays for this procedure. The cash price of $22,000 (some places as low as $19,000) is expensive. Insurance only allows around $3,000 for the entire procedure! IT'S A JOKE. Deductible and max out of pockets, essentially, don't matter because you pay cash up front and only get reimbursement what insurance pays.

I have medical insurance.
This is a medical issue.
Why am I paying still $19,000 out of pocket?

Broken hearted.

Almost no insurance covers cosmetic procedures. Sorry ?

There's always medical tourism !

My TT was completely covered by insurance. Guess that was lucky!

It's not cosmetic... Did you even READ my post? My TT and LBL have been approved to be "covered" as well.... But they don't cover the surgeons going rate.

49 minutes ago, damzelindistres5 said:

It's not cosmetic... Did you even READ my post? My TT and LBL have been approved to be "covered" as well.... But they don't cover the surgeons going rate.

Lol I read it. Fight them babe not me. Its not really covered if you can't find a surgeon for their price, then is it? Its a deterrent.

I was sympathizing with you because ... *Almost* no insurance will cover (at the market rate what the surgeon will charge - its an epic battle for reimbursement, so they will make you pay first then bill for reimbursement knowing they pay very little if at all) something primarily classified as cosmetic surgery as you are finding out. Hopefully you'll get it all covered and worked out !

Good Luck ?

Edited November 26, 20196 yr by GreenTealael

Unfortunately there's no one to fight lol. Surgeons won't do the procedure without cash in hand and insure will only pay what they pay. So I'm SOL in this case.

Yeah here in Australia it's near impossible to get any skin surgery of any kind unless in urgent medical necessity like life threatening otherwise insurance calls it plastic surgery....

I'm lucky I'm young and only need to lose around 120lbs so should be fine

In Australia, it doesn't have to be a life threatening issue around excess skin but there does need be a chronic medical issue caused by the excess skin. Here is a weight loss surgeon who also does what he calls body contouring where it is covered by medicare/PHI.

https://www.anthonyclough.com.au/body-contouring-surgery.html

Another lady I know on an FB group had her arms done under medicare.

Same point it's not very easy at all my surgeon explained it

Chronic not life threatening. Chronic as in long term/consistent skin rashes or other medical issues due to chafing skin. It isn't that difficult if there are documented medical visits to substantiate the issues.

Edited November 27, 20196 yr by Hop_Scotch

Basically the way it works here is that if insurance agrees that is medically necessary they will cover it. They have a rate at which they "deem the procedure" to be worth. For example a panniculectomy and tummy tuck would get paid out around $1,200. Additional thigh skin and buttock skin might add another $1,000. So even if the surgeon charges $22,000 insurance is only paying them around $3,000. The rest is the patients responsibility. They won't do it without cash in hand.

On ‎11‎/‎27‎/‎2019 at 2:28 PM, damzelindistres5 said:

Basically the way it works here is that if insurance agrees that is medically necessary they will cover it. They have a rate at which they "deem the procedure" to be worth. For example a panniculectomy and Tummy Tuck would get paid out around $1,200. Additional thigh skin and buttock skin might add another $1,000. So even if the surgeon charges $22,000 insurance is only paying them around $3,000. The rest is the patients responsibility. They won't do it without cash in hand.

Hi!

I'm wondering where you're from/what type of insurance plan you have? I actually work for a large insurance company and if you're going to an in-network plastic surgeon, they are contractually bound to accept whatever rate the insurance company offers. So, if you were trying to get the service done by an out of network provider, that could be the problem.