Has anyone had TT surgery covered under their insurance? - Page 2 - ThinnerTimes

Blueyz · 04-03-2006, 09:15 PM

My PS surgeon wrote up the referral and used all sorts of codes to get me covered. I was approved mainly because of my hernia. I had two TT's, on horizontally, and one vertically. Both were covered by the insurance, but only because I had hernia revision surgeries. Not a fun way to go. I have one more revision and it is going to be difficult because my doctor is no longer contracted with my HMO. He needs to do the surgery and says he will do it.

As for the B lift, I had to pay for it. Well worth every penny.

Stuart · 04-04-2006, 10:48 PM

Quote:

Originally Posted by ThinnerTerri

Hi I have an appointment for a breast reduction, but my Dr says the insurance companies arent covering tummy tucks. Any advise??

I have a friend who is a Plastic Surgeon and he says it is a crap shoot. He has had patients with skin hanging down to their knees who were denied and other patients who had minimal redundent skin and were approved. My wife requested a breast lift, thigh lift, and an upper arm lift. I sure that she would be approved for the breast lift, but I thought the rest would be denied. She was approved for all of the requested procedures AND a tummy tuck (She had the Sampler Platter!!). I, on the other had, have been denied twice for P.S. referral. I constantly suffer from terrible, painful rashes. Even with documentation of antibiotics, oral anti-fungals, and anti-fungal powder, my medical group seems to feel that P.S. is not medically necessary. They would rather keep giving me antibiotics and gobs of pain meds as opposed to fixing the problem. Plastic surgery is a covered benefit with my insurance (Pacificare) and I will eventually win.

HAMPTON5555 · 04-05-2006, 03:50 PM

It is my belief that insurance coverage is subjective to the carrier as well as the mood of the day!

I have health net select. They quickly aproved my hernia repair, but after seeing a general surgeon, I was reffered to a plastic surgeon because of the location of the hernia which in turn allowed me a pausectumy (covered). However, it is important to note that a panusectomy is simply skin removal and not an abdominalplasty which is a true tummy tuck. Where the muscle and fat are corrected also, not just the skin.

For me my Dr. did not even take a photgraph and I was approved. Doctor said good thing as I really did not have that much of the tummy skin, mostly misshapened and wrinkled. I opted to have a partial lower body lift combined with the approved procedures and after all was said and done, I beleive my portion was about 10K$ or so.
I want to do a breast lift but I have iron issues and Doc. won't talk about it untill that gets resolved.

Tummy tuck sounds so sweet and inocuous, but let me just say....surgery is surgery! Prepare yourself it is an ordeal.

I had mine 3 weeks ago and while I am healing nicely and I like the results, it is still a painful process.

I reccommend waiting for as long as you can since the skin retracks in time and you may not need as much work as you think you do!
Rain

kimNH · 04-06-2006, 06:34 PM

Hi to all of you,
Sorry but I haven't posted in a very long time.
I was wondering if anyone has gone out of the US for Plastic Surgery?
I am planning on going to San Jose, Costa Rica for my plastics since I have been denied for my reconstruction to breasts, thighs, abdomen and all this hanging skin is discusting! I have worked long and hard to lose the weight and exercise after the GBS, and I have lost 130 lbs, and the Ins. Co. is not going to stop me from doing this. So I am scheduled for PS on May 10th at the Rosenstock/Lieberman Surgery Clinic. I will be getting an extended abdominoplasty with tightening of the muscles, lipo to abdomen, hips and outer and inner thighs, also a mons lift, and inner thigh lift, and a breast lift and implants put in. I am so excited to get this all done.
I have looked long and hard for all the info, and have studied so much for all the ins and outs, and the pros and cons. I feel very comfortable with my decision, and I have talked to at least 60-80 others that have gone there and I have seen their results and the doctors there are wonderful.
If anyone has gone to Costa Rica please let me know how you did, I am really needing to know.
Thanks for listening and for all your help.
KimNH
305/175/below goal wt

HeatherT · 05-09-2006, 02:31 PM

Quote:

Originally Posted by bridgetgirl

Its not cosmetic, its reconstructive, You have the burden of proof showing how detrimental the hanging skin is too your health. Like at it this way,if a women needs a masectomy, if she wants it they will give her a breast prosthesis. This is elective, and cosmetic. But how detrimental is it to her psyche to llok at her chest post masectomy? Devistating. the same can be sad for us, and if anyone disagrees that you can prove without reasonable doubt how terrible ythe skin is, then its sheer descrimination. Rashes, poor hygeine, sores, back pain, shoulder pain, a pannus that hangs to your private areas... etc, this on top of the look og horrid hanging skin can be mentally devistating as well. Thinking, I lost 150 pounds, I have this pain, I look awful, still look fat (skin) become depressed and eat their way out of the surgery.
If you document your health detrements, they have no other choice but to approve. And if your carrier doesnt, you appeal, and appeal agin. If you have ot takeit all the way to the Supreme Court of Appeals, you do it. Otherwise its just descrimination. It has been my experience that most people either dont try, and if they do and they get denied they dont appeal. They find it easier to get a loan or take a 2nd mortgage on their home. If thats an option for you , cool. But for some it not.

Insurance carriers will pay for breast lifts, but NOT implants.

Good luck n stuff.

I have Healthnet HMO & is says it will cover reconstructive but i dont know where to begin...or if there is enough hanging...i am a little eary to be thinking this i guess becuase i hope i am not done losing but i am wondering...what insurance did you have cover the surgery? i would LOVE to have the tummy, thigh, & breasts lifted they hang & its gross! but i dont think i want arms done as i scar really bad & dont want to not wear tanks now that ifinaly feel good in them even with the little wings i do have i can live with it! but the roll around the middle BUGS me...i have only lost a total of 88 pounds since i first saw te surgeon - & really only 75 since surgery - but i will be in normal bmi in 2 pounds so i am happy with the results - i have lost 88% of the weight that they felt i could lose ( the Dr made me gain 13 pounds before she would refer me to the surgeon.... but than i lost that before surgery so really i was only 238 for less than 6 months i was 225 for a few years & the insurance said i wasnt heavy enough to have surgery....what do you think bridget what should i be doing to prepare ad get that tummy, thigh & breast lift covered? does anyone have a good letter to get the insurance to cover it???

thank you so much for the information in advance!

Mavisavis · 05-09-2006, 04:09 PM

Quote:

Originally Posted by kimNH

Hi to all of you,
Sorry but I haven't posted in a very long time.
I was wondering if anyone has gone out of the US for Plastic Surgery?
I am planning on going to San Jose, Costa Rica for my plastics since I have been denied for my reconstruction to breasts, thighs, abdomen and all this hanging skin is discusting! I have worked long and hard to lose the weight and exercise after the GBS, and I have lost 130 lbs, and the Ins. Co. is not going to stop me from doing this. So I am scheduled for PS on May 10th at the Rosenstock/Lieberman Surgery Clinic. I will be getting an extended abdominoplasty with tightening of the muscles, lipo to abdomen, hips and outer and inner thighs, also a mons lift, and inner thigh lift, and a breast lift and implants put in. I am so excited to get this all done.
I have looked long and hard for all the info, and have studied so much for all the ins and outs, and the pros and cons. I feel very comfortable with my decision, and I have talked to at least 60-80 others that have gone there and I have seen their results and the doctors there are wonderful.
If anyone has gone to Costa Rica please let me know how you did, I am really needing to know.
Thanks for listening and for all your help.
KimNH
305/175/below goal wt

I would be interested in knowing also......in the safety, the results, the cost, etc. I am not likely to get anything covered......but I hate the flabby look. It makes me still feel fat no matter what size I wear.

Mavisavis · 05-09-2006, 04:13 PM

Quote:

Originally Posted by HeatherT

i dont think i want arms done as i scar really bad & dont want to not wear tanks now that ifinaly feel good in them even with the little wings i do have i can live with it! but the roll around the middle BUGS me...i have only lost a total of 88 pounds since i first saw te surgeon

I know that you and I have talked about our similar stats, but I thought it was funny that this is my EXACT main gripe. That daggone roll in the middle.

I call it my "hate handles"! lol Now, you say 88 pounds, but you pre-empt it with the word ONLY........hello.......there is no only there!! You have done a fantastic job and have lost a lot of weight....now don't let me catch you saying only again!

HeatherT · 05-09-2006, 04:21 PM

Quote:

Originally Posted by Mavisavis

I know that you and I have talked about our similar stats, but I thought it was funny that this is my EXACT main gripe. That daggone roll in the middle.

I call it my "hate handles"! lol Now, you say 88 pounds, but you pre-empt it with the word ONLY........hello.......there is no only there!! You have done a fantastic job and have lost a lot of weight....now don't let me catch you saying only again!

i love you marty thank you i wont say only again

i just hate the fat roll "hate handles" mine is a "hate grab bar" because it is mostly right in front! so much it is the only thing that still make me jump when my hubby tries to hug me when i am sitting at the desk...but then he will grab my hip bone and say your bones are popping out everywhere and i smile

but i know that roll is just hanging over the other side !

but i am a little afraid of skin removal what are the complication rate and what are the most common compliications? I know the most common complication for WLS is a stricture & I got that but its fixed now thank god

Mavisavis · 05-09-2006, 07:58 PM

Quote:

Originally Posted by HeatherT

i love you marty thank you i wont say only again

i just hate the fat roll "hate handles" mine is a "hate grab bar" because it is mostly right in front! so much it is the only thing that still make me jump when my hubby tries to hug me when i am sitting at the desk...but then he will grab my hip bone and say your bones are popping out everywhere and i smile

but i know that roll is just hanging over the other side !

but i am a little afraid of skin removal what are the complication rate and what are the most common compliications? I know the most common complication for WLS is a stricture & I got that but its fixed now thank god

I guess I don't know much about the complications.......I need to read up on it. But I do hear a lot about the pain of it.

I keep hoping my roll will firm out some more......some long termers say it will go away some with time. I think mine has decreased a bit the past few months. I used to spend so much time trying to get dressed to go anywhere......I'd be throwing clothes around...all over that stupid roll. Now it's not quite so bad as long as my pants aren't snug. It just really plays into me not seeing my true size. I feel chubby most times and the past few days actually feel fat again. But yet, I do feel bones....I joke with my BF like, hey look.....I got some new bones. Now my friend who had it a week before me can see herself without feeling fat. In fact, sometimes I think she sees herself even thinner than she actually is. Oh what a head case I am.

Cathrynliz · 05-07-2008, 01:59 PM

Hi!
I haven't had gastric bypass surgery yet and found your question because I was doing a search for people who had had the gastric bypass in Costa Rica.

First, I wish you luck, and I also want to let you know that I have been to Costa Rica twice and it is a lovely place - not third world, particularly - and very clean, environmentally aware and absolutely beautiful. That is why I am considering it for my gb.

I am looking forward to hearing about it when it's over.

Take care,

Cathrynliz

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