After a two hour appointment consisting of a million
questions (I was armed and ready with a pretty long list), an evaluation (with
me in my skivvies), and a photograph session (still in my skivvies...) my plastic surgeon is compiling a
request for approval from my insurance company for my surgery. Even though the insurance company may cover
the procedure (yes, there is still a possibility my insurance might not cover
this) they need evidence in order to make a decision. The surgeon will submit a
letter from his office and one from my primary care doctor explaining the
medical need for the procedure along with the photos taken today. The downside
of this is that the approval for the procedure is at the discretion of the insurance
agent reviewing it and even though I meet all the criteria (most important one being
that my skin hangs into my pubic region- yes, one day I will share pictures in
case you are curious as to what that looks like) my insurance can still deny the claim. Even though I am
healthy, have maintained this weight loss for almost 2 years, I am active, and
take care of myself AND I have a legitimate need for this procedure- they can
still say no. So that kind of sucks BUT I am staying optimistic. It will all
work out as it should. Oh, and in case you are wondering it will take anywhere
from two to six weeks to hear back from the insurance company. Ugh! More
waiting.
Now as far as the procedure itself goes, I learned today
that most insurance companies cover only what is called an abdominal panniculectomy
which is for the area below the belly button.
This is covered because there are medical issues (chafing, open sores,
trouble urinating, even yeast infections) associated with having skin that hangs
over the pubic region. The area above the belly button is considered cosmetic
only and therefore not covered by most insurance companies. An abdominoplasty
covers both regions. Both the
panniculectomy and the abdominoplasty are made from the same incision and I
can, in fact, have the panniculectomy (if approved) and the top
half/abdominoplasty done at the same time. I would just have to pay out of
pocket for the top part- which we got a quote for. Not cheap but doable. Pretty
much what I thought it would cost.
My surgeon really emphasized the fact that if I have the
lower half done but not the top half I will be really unhappy with how I look.
And I agree. Especially after he showed me basically how much will be removed
from my lower area, you know by pinching and pulling and poking. I also asked
about lipo, a question a friend who underwent these types of procedures told me
to ask, to which I was told that I don’t have anything to lipo out. That pretty
much everything I see is just excess skin and when it is all removed and the
underlying fascia is tightened I will see how very little fat I have in the
area. That was crazy to hear but he told
me to think about the fact that I lost a whole person’s worth of weight and how
I shouldn’t be surprised that it left me
with a whole person’s worth of extra skin.
I also asked about the timing of this all. As I mentioned
previously about wanting to do this around Christmas since it would coincide
with the university being closed. The surgeons there work through the holiday
season, for the most part, and I was assured that even if it takes 6 weeks to
hear back from the insurance company I would still be able to schedule it
around the holiday. So that is really great news for me. Once we hear back from
the insurance company I will be able to schedule the surgery that same day and
the surgeon’s assistant told me she would do everything possible to get me in
on or as close to the date I wanted. Yay!
I will definitely do another post where I write up all the
questions, answers and discussion points from today’s appointment but for now I
just wanted to get something out there so you all know what is going on. I will
tell you this that the doctor told me (and Paul, who surprised me at the
appointment) that I was a perfect candidate for the procedure and when asked
what I needed to be doing to prepare for it, so I can have a successful
outcome, he told me to just keep doing what I’m doing.
Please feel free to ask me any questions you want about
this. I know that this surgery is pretty off topic for this blog but it is kind
of a big deal and will be a big part of my life for a while- especially when I
am immobile and there will be no running or riding. Lol!
I'm so happy for you! Surgery is scary but you've worked so hard to get where you are and you deserve to show off your super hot bod ;)
ReplyDeleteThanks! I'll be happy just to not have to worry about chaffing on my belly anymore. That is no fun at all!
DeleteGreat report! Looking forward to what the insurance company says. We didn't even go the insurance route because my plastic surgeon (that I loved!) wouldn't do split billing. I ended up paying out of pocket for it all. He did offer to do two separate surgeries, but I really didn't want that.
ReplyDeleteThis seems like a pretty common issue. While I was getting checked in someone called, whom had the same insurance as I do, and the receptionist told them the whole below the belly button only thing. I am just trying to stay hopeful that it is covered.
DeleteI was told that I don’t have anything to lipo out <-- I am so not surprised by this. I'm excited for you. The waiting is going to suck though. I'll be crossing my fingers and sending smart decision mojo to the insurance agent. :)
ReplyDeleteThanks Sid! As always, I appreciate your support!
DeleteP.S.- you crack me up!