Just got back from local surgeon's office - added pictures

[DSRIGGS]

So I just took a look in our "Health Benefit Booklet" and found this passage on reconstructive surgery.. I think I am covered

Sorry it is hard to read but I can't seem to make it any larger. The way I read this it says "to correct significant deformities caused by........an earlier treatment in order to create a more normal appearance". Then it goes on to talk about symmetry after mastectomy. In my mind the DS caused great wait loss, which caused pannus, which I now have to right to have corrected to create a more normal appearance.

Am I smoking dope or is that sound logic?

 

[Marquis Mark]

Scott, I'm stunned by how little belly hang you have! May I ask how old you were when you started putting on weight?

I noticed that the under armor type shirt I am wearing today really shows the bulge from my hernia so I took a couple pictures in the mirror with the shirt on, and then with it pulled up.

My stomach is relatively flat, in fact when I lay down on my back I still have a huge divot under the bottom of my chest/ribs. That being said I have some loose skin that you see at bottom and a little bit of a panniculus. The picture is taken in the mirror so that big bulge you see is the hernia and it is to my right side of my umbilicus extending out and down probably 3 inches each way. It actually even goes back to the left side at the bottom. Anyway, thought this picture showed a little bit of what it is I am messing with.

and yes, those are University of Illinois Fighting Illini sleeping/lounge pants that I have on if you noticed the orang I.

Scott, I'm stunned by how little belly hang you have! May I ask how old you were when you started putting on weight?

 

[DSRIGGS]

Scott, I'm stunned by how little belly hang you have! May I ask how old you were when you started putting on weight?

How dare you ask such an insensitive question!

LOL

I was a chubby kid growing up but in high school was in great shape. I am just a hair under 6'2 and I could dunk in high school. I was 6'2 220 and all muscle when graduated high school. Mid 20's I was 260 and I really started gaining in the late 90's early 2000's when I got over 300 and kept creeping up.

I didn't publicly post my FUPA, or slid Pannus on this post because I did't want my sex pubic bone getting the ladies all hot and bothered, but there is some considerable loose skin there.

 

[Marquis Mark]

That, I think, explains it. I never got as heavy as you (40 BMI at my highest), but I started putting on weight when I was eight. I think my skin sort of "set" then. If I had gotten heavier later, like you, I might have had a different outcome.

Just got a letter from Kaiser saying that, due to lawsuit, they will cover plastic surgery but, on the stomach, it has to be bad enough to cover the genitals. Mine won't even come close. But I've learned in 19 years at Kaiser that it mostly depends on the surgeon. If they say OK, you're good to go. They don't question their doctors decisions. Plus I can make myself cry at will and have no shame about doing so if I think it'll work! No man wants to see another man cry.

 

[DSRIGGS]

That, I think, explains it. I never got as heavy as you (40 BMI at my highest), but I started putting on weight when I was eight. I think my skin sort of "set" then. If I had gotten heavier later, like you, I might have had a different outcome.

Just got a letter from Kaiser saying that, due to lawsuit, they will cover plastic surgery but, on the stomach, it has to be bad enough to cover the genitals. Mine won't even come close. But I've learned in 19 years at Kaiser that it mostly depends on the surgeon. If they say OK, you're good to go. They don't question their doctors decisions. Plus I can make myself cry at will and have no shame about doing so if I think it'll work! No man wants to see another man cry.

My highest ever weight was 364. For the last five years before surgery I was a fairly consistent 350

 

[Marquis Mark]

My highest weight ever was 325 (and only for few years) and I'm 6'3." We're all different!

 

[DianaCox]

Mark - if Kaiser refuses to cover your reconstructive surgery, you need to go to an outside plastic surgeon, and get a letter saying that you have an abnormal condition of the body, caused by a disease, for which reconstructive surgery can provide a more normal appearance, and that the improvement will be more than minimal. Then you can file an appeal with the DMHC.

Kaiser cannot decide by fiat what is an abnormal condition of the body, requiring it to be grotesque - and the lawyer who sued Kaiser will want to know if they refuse you (if you are not aware, I brought the first case applying the 1999 CA reconstructive surgery law to this class action attorney, and convinced him to take the case against Health Net; that suit was followed by a nice settlement when he used the same arguments against Blue Cross of CA, and now against Kaiser). So, if Kaiser refuses, PM me and I will send you the lawyer's contact information (not that you can't find it yourself - but I'd like him to know that I sent you, so he will pay attention).

 

[DSRIGGS]

BTW, insurance approval was submitted today so hope to hear something tomorrow or the next day.

 

[Marquis Mark]

Mark - if Kaiser refuses to cover your reconstructive surgery, you need to go to an outside plastic surgeon, and get a letter saying that you have an abnormal condition of the body, caused by a disease, for which reconstructive surgery can provide a more normal appearance, and that the improvement will be more than minimal. Then you can file an appeal with the DMHC.

Kaiser cannot decide by fiat what is an abnormal condition of the body, requiring it to be grotesque - and the lawyer who sued Kaiser will want to know if they refuse you (if you are not aware, I brought the first case applying the 1999 CA reconstructive surgery law to this class action attorney, and convinced him to take the case against Health Net; that suit was followed by a nice settlement when he used the same arguments against Blue Cross of CA, and now against Kaiser). So, if Kaiser refuses, PM me and I will send you the lawyer's contact information (not that you can't find it yourself - but I'd like him to know that I sent you, so he will pay attention).

Thanks, Diane, it will be at least a year before I'd even want to consider it, but I'll bear it in mind and I sincerely appreciate your feisty spirit and willingness to take up the sword. I dig people like you! My hunch is the surgeon won't turn me down. In fact, on my post surgery check up, Dr. Belzberg told me to check back with him when the time came which gave me the impression he would go to bat for me, if necessary. He's kind of a superstar down there and I think he has a lot of pull.

 

[Razbry]

I'm late to the conversation, but gerrrrrrrrrrrrr ohhhhhhhh baby....I loved your photos. LOL When I got a hernia the MD considered it an emergency (even though nothing was strangled or cut off). I was in OR in a nano second. I really think patient care is directly proportional to size of facility, how busy the surgeon is and how much they want insurance money.

 

[DSRIGGS]

I'm late to the conversation, but gerrrrrrrrrrrrr ohhhhhhhh baby....I loved your photos. LOL When I got a hernia the MD considered it an emergency (even though nothing was strangled or cut off). I was in OR in a nano second. I really think patient care is directly proportional to size of facility, how busy the surgeon is and how much they want insurance money.

My first hernia was an ER admit because after eating lunch I doubled over in pain and got dizzy, flushed and was sweating profusely. I was admitted with pain meds and was put NPO. Then after a day they had me do clear liquids and since that didn't cause pain they wanted to send me home.. Freaking geniuses...... SMH..... Anyway I told them that as soon as I ate real food the pain was going to come back so don't you think I should go on a regular diet first and see how I do? The resident said, oh yeah that sounds like a good idea. I ate and within 15 minutes the pain was back. Of course it was Saturday afternoon at this point so they said Dr Marshall will do surgery on you Monday..... So I had to wait two days because it was 6pm before they finally took me to the OR.

With this one it is more distention, bloating, diarrhea and cramping with an occasional bout of the sever pain that has gone away before having to head to the ER.

Hopefully within two weeks I will be fixed.

Thanks

 

[ampt]

Scott, trust me! I feel your "medical-insurance-is-the-enemy" pain! Keep on their asses! That is my advice! Perseverance pays off!