question about insurance - ThinnerTimes

theotherhalf · 03-01-2008, 04:54 PM

Hello everyone! I just found this wonderful website and I am excited to see such positive people. I had gbs on 12/13/05 and have lost 172 (half of me)

I was just approved for ps on the arms, breasts, and panus. My ps office did apply for the thighs but I was rejected. Here is a question for everyone: I have severe rashes and use cream and pills. If the pannus is removed I will still have a lot of skin left because of the thighs covering the creases of the vagina. This is where the rashes are the worst! Does anyone know why this was not covered? Should I fight with the insurance (BCBS of md) in order to get the rashes completely gone? Should I wait and get the pannus removed and then fight for the thighs? Thank you for your advice!

Lorie

fisher1000 · 03-01-2008, 06:25 PM

From what I understand, those of us who have insurance that covers plastics only need 6 months of documentation of whatever rashes we experience, and whatever treatment was undertaken to help, especially if it doesn't help at all. It seems odd that the ins. co. would cover everything else and not the place where the rash was the worst. I'd fight it, or at least appeal, but start with your doctor and make sure you have good back-up documentation first.

It sounds as though you have a clear case to warrant the plastics...maybe the insurance company just doesn't know how bad things are. Maybe if your doctor worded things a little differently, it WOULD go through!

Good luck!

-Mike

SueRN · 03-07-2008, 03:56 AM

It's really a crap shoot. But first, you really don't want to do it all at the same time. I had my TT and thigh lift done together. Insurance paid for both. I've had the stomach and the thighs revised. Insurance won't pay for the arms even though I had documentation fo chafing rashes with both topical ointments and oral antifungals. I appealed and lost. I have BCBSNC as well as I work for them too. I'm going to pay to have my arms done later this year when I get a final revision of my abdomen. You may want to break up the surgeries...like get arms and breasts done. Try to get more documentation on the thigh rashes while the upper part is healing. Resubmit or appeal the thighs.Then if all else fails, you pay for the surgeon fee for the thighs only and insurance will pay for everything else when you get your stomach done. It's expensive but it's so worth it if you can't get it approved thru insurance. Again, make sure there is adequate documentation from your PCP about your rashes. Sometimes, their documentation is really crappy and vague. I used to review the gastric bypass and plastic surgery requests, still to to help at times, and was amazed at the crap they would send in. It's not that the care was bad or negligent, they just never really documented everything that was said and done. Good luck. Sue