Tashika Evans
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- Apr 22, 2017
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plastics
- Thread starter Tashika Evans
- Start date
Help Support Bariatric & Weight Loss Surgery Forum:
Munchkin
Full of Fairy Dust
Welcome Tashika! I am one of the people who said you should come here. Congratulations on great work losing the weight. The first thing I am sending you is a link of a friend of mine to illustrate what really GOOD plastics can do for us. https://www.plasticsurgeonnewportbe...otos/orange-county-total-body-lift/patient-1/ I think that's just amazing.
Next.... We need to know where you live and what insurance you have. We need a copy of the EOC(Evidence of Coverage). The real document, not just what they told you on the phone. It should be @ 100 pages or so. And a synopsis of what you have done so far trying to get your plastics covered. There are people here who can really help you. It's not easy, and it takes time. But there is a good chance!
Next.... We need to know where you live and what insurance you have. We need a copy of the EOC(Evidence of Coverage). The real document, not just what they told you on the phone. It should be @ 100 pages or so. And a synopsis of what you have done so far trying to get your plastics covered. There are people here who can really help you. It's not easy, and it takes time. But there is a good chance!
Clematis
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Jbandmmomma
becky
Hey girl Hey! Glad you're here. These folks will do their absolute best to help.
Munchkin
Full of Fairy Dust
Yes. I know her IRL. I think several of us know her.
Tashika Evans
Member
- Joined
- Apr 22, 2017
- Messages
- 5
Where can I get a copy of the EOC and I'm in Augusta ga I had The gastric sleeve duodenal switch bypass I was 669 lbs I'm now 277 lbs I'm trying to upload before and after pics but it keeps saying my pics to large I also have Medicaid I tried making a go fund me page I'm just getting really frustrated because I'm getting all kinds of rashes and boils and my dr took all kinds of pics and nothing yet plzzzz help
Clematis
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Make sure your doctor documents every case of infection, medicines used, results and photographs same. You want to build up quite a compelling argument.
I lifted this from a post on another website from 2014:
"I had both Medicare Advantage Plan through AARP and Medicaid approval for skin reduction from my thighs. It was *not* a lift, simply removal of excess skin. They *will not* pay for lifts unless medically necessary.
Excision will most likely be approved if it's causing problems, like infection, rashes and skin erosion. I was getting cellulitis infections every other month once I lost weight (257 pounds). It got so bad that the last round had to use two different antibiotics to knock it down, which meant it was getting to be antibiotic resistant. I had documentation from my doctor and myself. Make sure you have a good detailed letter written. In my case, my doctor had me to draft a letter, she reworked it and added dates of treatment for the infections and sent it in with her documentation.
Choose your words carefully. Excision, which involves no cosmetic lifting, just removal of skin, is most likely to be approved, especially if it is contributing to or causing other health issues.
I've heard of some WLS patients who lucked out and got a surgeon who threw in the lift part just because. Not likely, but worth hoping for. Just don't get depressed if it doesn't happen.
My upper body, arms and breasts, will be on me, since they are not currently causing any medical issues. Some surgeons also have an age limit for certain procedures."
I lifted this from a post on another website from 2014:
"I had both Medicare Advantage Plan through AARP and Medicaid approval for skin reduction from my thighs. It was *not* a lift, simply removal of excess skin. They *will not* pay for lifts unless medically necessary.
Excision will most likely be approved if it's causing problems, like infection, rashes and skin erosion. I was getting cellulitis infections every other month once I lost weight (257 pounds). It got so bad that the last round had to use two different antibiotics to knock it down, which meant it was getting to be antibiotic resistant. I had documentation from my doctor and myself. Make sure you have a good detailed letter written. In my case, my doctor had me to draft a letter, she reworked it and added dates of treatment for the infections and sent it in with her documentation.
Choose your words carefully. Excision, which involves no cosmetic lifting, just removal of skin, is most likely to be approved, especially if it is contributing to or causing other health issues.
I've heard of some WLS patients who lucked out and got a surgeon who threw in the lift part just because. Not likely, but worth hoping for. Just don't get depressed if it doesn't happen.
My upper body, arms and breasts, will be on me, since they are not currently causing any medical issues. Some surgeons also have an age limit for certain procedures."
Clematis
Well-Known Member
- Joined
- Sep 5, 2015
- Messages
- 1,705
Have you had a consult with a plastic surgeon? See if you can find one that will accept Medicare. (If it is one who posts on RealSelf they also may offer a free or reduced fee consultation if you mention you saw them on RealSelf when you call to book. I found that they will not remind you of this so you need to remember to say "do I get a discount if I mention RealSelf?")
At that appointment ask them what you need to do to prove medical necessity. If they accept Medicare, they should know how the system works and so can advise you on how to proceed.
At that appointment ask them what you need to do to prove medical necessity. If they accept Medicare, they should know how the system works and so can advise you on how to proceed.
Munchkin
Full of Fairy Dust
You can make this happen but it won't be fast. EOC's are usually available online. You need to know the exact name of your plans and go look them up. There are different flavors of Medicaid, etc so you have to know the exact names. You can also call the plans and ask them to send you the EOC. I looked online and it's impossible to pull the information without knowing the name of the plan.
Plastics are what you WANT. Reconstructive surgery is what you NEED.
Next, never call these procedures plastic surgery. Erase plastic surgery from your vocabulary right now. It is reconstructive surgery. It's just like a woman who has her breasts reconstructed after mastectomy. You are not asking to be remade into a supermodel because you are vain. The hanging skin impedes normal movement and is in fact dangerous and needs to be removed. It is also a health hazard and causes infections, boils, and is impossible to keep clean. These are the things you need to talk about. Have you burned your batwings trying to cook? If you have, talk about that too. Everyday normal things are difficult to impossible for you to accomplish because of the hanging skin. You need reconstructive surgery because the hanging skin impedes your daily life. You have a difficult time working or looking for a job because of hanging skin. You live in your skin and I bet you can think of more issues too. You also can't exercise because of the skin. You get the idea.
Keep on taking pictures and making lists of things you can't do because of the skin issues. I know it's frustrating but keep on.
Make a new ally. Go see your Social Worker armed with all this information. Keep in mind this person's ultimate goal is to get you back in the workforce. Ask for help. Those people know a lot and if they get behind you, they can help. Every state has programs average people do not know about. The Social Workers know.
Plastics are what you WANT. Reconstructive surgery is what you NEED.
Next, never call these procedures plastic surgery. Erase plastic surgery from your vocabulary right now. It is reconstructive surgery. It's just like a woman who has her breasts reconstructed after mastectomy. You are not asking to be remade into a supermodel because you are vain. The hanging skin impedes normal movement and is in fact dangerous and needs to be removed. It is also a health hazard and causes infections, boils, and is impossible to keep clean. These are the things you need to talk about. Have you burned your batwings trying to cook? If you have, talk about that too. Everyday normal things are difficult to impossible for you to accomplish because of the hanging skin. You need reconstructive surgery because the hanging skin impedes your daily life. You have a difficult time working or looking for a job because of hanging skin. You live in your skin and I bet you can think of more issues too. You also can't exercise because of the skin. You get the idea.
Keep on taking pictures and making lists of things you can't do because of the skin issues. I know it's frustrating but keep on.
Make a new ally. Go see your Social Worker armed with all this information. Keep in mind this person's ultimate goal is to get you back in the workforce. Ask for help. Those people know a lot and if they get behind you, they can help. Every state has programs average people do not know about. The Social Workers know.
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