Tashika Evans
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- Joined
- Apr 22, 2017
- Messages
- 5
how to go about getting insurance to pay for skin removal plzzzz help
Skin removal
- Thread starter Tashika Evans
- Start date
Usually the only skin removal insurance pays for is a pannictomy (just the excess skin of the stomach area). And documentation is critical. Skin rashes, etc. Remember, a panni is NOT to make it nice to look at or tighten underlying muscles. JUST remove the excess.
IF you live in California, you have the right to get excess skin removed but they make it as hard and publicly embarrassing as they can.
Start by reading your insurance policy, the Evidence of Coverage which is typically 80 -100 pages long.
Munchkin
Full of Fairy Dust
I think Tashika has a real case for medical necessity. I saw pictures on FB.
What procedure do you need? Just a panniculectomy (amputation of the skin - no muscle tightening)? Generally, if the skin flap covers below the top of your pubic bone, AND you have documented skin rashes that won't clear up (you need photographic EVIDENCE of both of these, in repeated pix taken by a doctor), it will be covered. The cosmetic results of a panniculectomy are usually pretty shabby - ask how much more your surgeon will charge to do a cosmetically nicer job and see if you can pay the difference.
Or do you need more? Do you have a hernia?
Or do you need more? Do you have a hernia?
Tashika Evans
Member
- Joined
- Apr 22, 2017
- Messages
- 5
I need EVERYTHING
Jbandmmomma
becky
Shika,
Diana and Larra and the other ladies and gents here will do what they can to help. When they ask the questions - you gotta be specific in your answers. "EVERYTHING" won't really help. You should maybe list, by order of priority, what the areas are that you and your physicians think need reconstruction. Might help you to put together in the list what you've got so far for reason/documentation for each specific area. What causes the MOST restriction on your ability to live normally/get a job/etc?
Hope that helps,
b
Diana and Larra and the other ladies and gents here will do what they can to help. When they ask the questions - you gotta be specific in your answers. "EVERYTHING" won't really help. You should maybe list, by order of priority, what the areas are that you and your physicians think need reconstruction. Might help you to put together in the list what you've got so far for reason/documentation for each specific area. What causes the MOST restriction on your ability to live normally/get a job/etc?
Hope that helps,
b
Tashika Evans
Member
- Joined
- Apr 22, 2017
- Messages
- 5
I need arm lift
Breast lift
Tummy tuck
Thigh lift
Skin removed from thighs
Liposuction in thighs and hips and calfs
Breast lift
Tummy tuck
Thigh lift
Skin removed from thighs
Liposuction in thighs and hips and calfs
You should find an EXPERIENCED reconstructive surgeon who specializes in post-massive weight loss (not just bariatric) surgery - your situation is fairly extreme and great skill is required. And someone with that level of skill probably knows how to get much of those procedures approved.
You could move to CA ... I don't think the CA Dept of Managed Health Care would have ANY problem overturning a denial for your situation!
You could move to CA ... I don't think the CA Dept of Managed Health Care would have ANY problem overturning a denial for your situation!
Spiky Bugger
Well-Known Member
- Joined
- Jan 5, 2014
- Messages
- 6,201
When Diana said to move to CA, she said what I was thinking...but maybe there is something closer to home. I will screw this up, but it will be CLOSE to the right story. MAYBE, some other state's laws have evolved along the same lines.
Many years ago, CA decided (and this is why I am so opposed to buying insurance out of state) that insurance companies selling insurance here had to cover reconstructive procedures for people whose bodies, essentially, didn't look right--or work right, I think--because of disease or accident or birth defect, etc. In other words, if you lost a breast due to cancer or anything else, not having two breasts was not a normal appearance, so they had to cover it. I knew a woman whose daughter had "a boob and a half." That's just how they grew! Surgery was required to create a normal appearance...and it was covered, even though nothing was medically wrong with either breast. If you played with a chain saw and amputated an ear, building something that made your head look right was covered.
Before this law, insurance companies covered only MEDICALLY necessary stuff. They would remove a diseased breast, but not try to make you look normal. If you could hear, they didn't pay to replace the missing exterior ear...even if you had to duct tape your glasses to your head.
That went on for a while and then some smart ass woman who likes to read small print figured out that somewhere along the line, "obesity" (or maybe "morbid obesity") was redefined by the medical world as a DISEASE.
WELL THEN, thought the smart assed woman, if my body got funny looking because of the disease of obesity, then making it look kind of normal should be covered under the law.
She tried. Her insurance denied her. And she got huffy. And fought about it. And got the state on her side. And eventually found some attorneys, and other people who had the same problem, and turned her huffyness into a class action suit.
Now, we now her story had a happy ending because, for a change, the smart ass woman had nothing to say about the entire case. Nothing. (Truth be told, she told folks in advance that if the case came to a $ettlement, there would likely be a non-disclosure agreement involved and that she would be unable to answer questions after that date. And then she just shut the hell up. Which means EITHER they have taken her family hostage OR she won a BUNCH of money...and we know her family is out and about.)
So, finding resources IN your state or even in a nearby state, will be a big job...but it might potentially work.
And...meanwhile...if your excess skin in SOME areas is causing medical problems...maybe that can be covered now. Maybe?
Good luck!
Sue
Many years ago, CA decided (and this is why I am so opposed to buying insurance out of state) that insurance companies selling insurance here had to cover reconstructive procedures for people whose bodies, essentially, didn't look right--or work right, I think--because of disease or accident or birth defect, etc. In other words, if you lost a breast due to cancer or anything else, not having two breasts was not a normal appearance, so they had to cover it. I knew a woman whose daughter had "a boob and a half." That's just how they grew! Surgery was required to create a normal appearance...and it was covered, even though nothing was medically wrong with either breast. If you played with a chain saw and amputated an ear, building something that made your head look right was covered.
Before this law, insurance companies covered only MEDICALLY necessary stuff. They would remove a diseased breast, but not try to make you look normal. If you could hear, they didn't pay to replace the missing exterior ear...even if you had to duct tape your glasses to your head.
That went on for a while and then some smart ass woman who likes to read small print figured out that somewhere along the line, "obesity" (or maybe "morbid obesity") was redefined by the medical world as a DISEASE.
WELL THEN, thought the smart assed woman, if my body got funny looking because of the disease of obesity, then making it look kind of normal should be covered under the law.
She tried. Her insurance denied her. And she got huffy. And fought about it. And got the state on her side. And eventually found some attorneys, and other people who had the same problem, and turned her huffyness into a class action suit.
Now, we now her story had a happy ending because, for a change, the smart ass woman had nothing to say about the entire case. Nothing. (Truth be told, she told folks in advance that if the case came to a $ettlement, there would likely be a non-disclosure agreement involved and that she would be unable to answer questions after that date. And then she just shut the hell up. Which means EITHER they have taken her family hostage OR she won a BUNCH of money...and we know her family is out and about.)
So, finding resources IN your state or even in a nearby state, will be a big job...but it might potentially work.
And...meanwhile...if your excess skin in SOME areas is causing medical problems...maybe that can be covered now. Maybe?
Good luck!
Sue
Sandy
Been Around A While
Shika, did I see yesterday that you have a least won a first battle with regards to insurance and plastics? Weren't you just approved for liposuction for your thighs/legs? Does this mean you have a plastic surgeon that has experience in getting insurance approvals? Or is s/he having trouble getting other medically necessary things approved?
