We have been discussing insurance companies quite a bit lately in hopes of identifying the issues that affect coverage determination, and educating patients on how to submit claims. Only a small percentage of procedures performed by Dr. Slenkovich are covered by insurance, but these present a significant amount of frustration for our staff, as well as for our patients.
Over the last several days I have spoken with a number of men and women who contacted our office to discuss post-weight loss surgery. Each one of these dear people should be commended for taking action to lose weight. By making the decision to have gastric bypass surgery (or other procedures) they have radically changed their lives. Unfortunately, they are almost always left with an unmanageable amount of excess skin that has to literally be “tucked in” under their clothes. They harbor the hope that their insurance company will agree to pay for the surgery needed to remove this skin. It has been my unhappy task to advise them that most insurance providers still consider this type of surgery “cosmetic” and therefore “not a covered benefit”. If they do offer any financial help at all, it is for a very limited “panniculectomy”, a procedure to remove the excess skin across the “pannus”, or lower abdomen. Reducing the skin hanging from the arms, back, thighs, buttocks, etc, is somehow considered a purely cosmetic procedure. We are really hoping to influence a change in the insurance community’s position on this.
Every post-weight loss patient I have spoken with has a story to tell… some of them have broken my heart. One woman called this morning to ask if her insurance policy would cover a procedure to reduce the size of her thighs. She has lost 115 pounds, but the skin and fat remaining on her upper legs has caused blistering and lesions, not to mention the physical strain when she’s worked a 12 hour shift at her hospital job. She says she’s ashamed to go out in public with her grandson, is unable to find pants that fit, can’t wear a skirt and would never consider shorts or a bathing suit. A young man I spoke to yesterday said he’d lost 148 pounds and looks better now than he has in years, but he won’t even think about asking a girl out on a date because he is so embarrassed by the secret that he’s hiding yards of hanging skin under his clothes. These are real people. They work hard, pay their premiums, and expect to have their insurance company fulfill its promises to them. (Think about the sentimental jingles and slogans these same companies use in their advertising. They pay millions to convince us that they care, then refuse to pay for our medical care!)
In an attempt to address these frustrations, we have added language to our patient intake paperwork, and will be incorporating more insurance-related information into our website to assist people as they research these types of surgeries. Do any of you have experience with plastic surgery after weight loss?
Suzanne London Patterson, Surgery Center Coordinator
