any updates on insurance coverage for plastics?

[Bridg]

Hi everybody,

I'm at the point now where I'm ready to pursure plastic surgery. I've looked online for any kind of guidance on getting insurance to cover it without much success. I've read my policy - there needs to be medical reasons (which I have for everything I want done except the boob job). I guess I'm looking for advice from people who have already gone through this part to find out if there are any tricks or tips to writing the pre-auth letter, finding the "right" surgeon (one who is good at his/her craft and good at fighting for me) in the Twin Cities area, and generally knocking down whatever obstacles will stand between me and the plastics. I have HealthPartners insurance and had no trouble at all getting approved for the DS. Would it help to go through the same medical practice to get the plastics done? Any advice would be appreciated.

Thanks!

[jpcello]

Bridg - it all depends on the plastic surgeon you choose. Try to find one who has experience with WLS patients. They usually know how to write the medical necessity letters needed to get insurance to pay.

I first went to a plastic surgeon who was highly recommended but didn't have a lot of experience with bariatric patients. She submitted to my insurance co and they turned it down immediately. I then went to a plastic surgeon who was recommended by other WLS patients I knew and had alot of experience working with bariatric patients. He submitted to my insurance and woohoo, they agreed to pay for my tummy tuck. I had the TT paid by insurance and I paid for a breast lift, which was done at the same time. I only had to pay for the surgeon's fees for the lift, because insurance was covering the OR, etc. through the TT. Altogether, it cost me about $5K out of pocket.

If you had your DS in the same area you live, definitely talk to other WLS patients to see who they went to. My DS surgeon had a plastic surgeon working with his practice, but he wasn't board certified in plastics so I wouldn't go to him.

Just make sure the plastic surgeon has experience with WLS patients, because plastics for us is totally different than someone who just wants a little nip/tuck.