My Stomach hit the Floor

[southernlady]

In California, if it looks abnormal (subjective), it is supposed to be covered.

“Reconstructive surgery” means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following:
(A) To improve function.
(B) To create a normal appearance, to the extent possible.

California Code, HSC 1367.63

However, it appears HealthNet (who I won my case against) has rewritten their reconstructive surgery policy to explicitly ATTEMPT to exclude skin removal - but that should not apply to post-bariatric surgery skin removal.

https://www.healthnet.com/content/dam/centene/healthnet/pdfs/general/ca/policies/CosmeticandReconstructiveSurgery.pdf

That’s cause you won against them and they ended up paying not only for yours but many others. Sounds like someone needs to fight them again.

 

[floridaweightlossmd]

Panniculectomy covered due to rashes / wounds in fold with abdominoplasty covered due to hernia.

It's great to hear that you're getting coverage for both procedures! The benefits of an panniculectomy are significant, especially for those experiencing rashes or wounds in the abdominal fold. Not only does this surgery help improve comfort and hygiene, but it can also enhance overall mobility. Combining it with an abdominoplasty to address a hernia is a smart move, as it can lead to a more comprehensive improvement in both function and appearance. Wishing you the best on your journey to recovery!

---

 

[hilary1617]

It's great to hear that you're getting coverage for both procedures! The benefits of an panniculectomy are significant, especially for those experiencing rashes or wounds in the abdominal fold. Not only does this surgery help improve comfort and hygiene, but it can also enhance overall mobility. Combining it with an abdominoplasty to address a hernia is a smart move, as it can lead to a more comprehensive improvement in both function and appearance. Wishing you the best on your journey to recovery!

HI - I had the panniculectomy while SMO, 20 years and a pregnancy ago! I'm so glad it was done! I've also had the DS and multiple abdominal surgeries due to cancer since. Thus, the abdominoplasy didn't hold, I have pretty significant diastasis recti, but the panniculectomy is still of great benefit, particularly given the drastic change in my weight and shape over the years.