I am on the path to have gastric bypass Surgery and I am so worried about the excess skin thats going to be left I have seen many friends and coworkers that have had the surgery and the skin seems unavoidable since you lose weight so rapidly and I was also a yo yo dieter all my life so Im not as firm as I once was..Does anyone know if Insurance covers this removal or I also heard that burn units accept it? I dont know if any of this is true so I would just like some opinions on the matter or if a plastic surgeons have payment plans.. Thanks
Congratulations Denise on your decision to have gastric Bypass, I hope the procedure goes well and that your life goal of better health is achieved. I did not have GP but have the same excess skin, mine attributed to lax lifestyle, late night fast food and abdominal/back surgeries which cut the muscles (my own little excuse for bad habits). I've lost fifty pounds with lifestyle changes; I am though probably much older than you, with some of my excess skin age related.
I am retired from a major health insurance company and can tell you how my former employer treated claims for the removal of excess skin following weight loss. Sadly it is true most insurance companies consider this is an exclusion (cosmetic and not medically necessary). There can be exceptions, mostly where the amount of excess skin can be proven to interfere with the quality of life with the key being it must be "medically necessary". Contact your insurance carrier for specifics as there should be Medical Policy either defining coverage or confirming exclusion of the excess skin removal procedure(s). Usually required are operative notes documenting the amount of skin removed and a letter(s) explaining the excess skin interferes with excercise/walking or specific problems such as chafing of the skin or infections, etc.)
That said, for all weightloss (bypass and otherwise), the skin's elasticity is minimized by excercise and healthy diet. Weightloss physicians generally have nutrition and fitness experts which can council you in this area......knowing far more than I do about this. Also many weightloss physicians can recommend plastic surgeons specializing in these procedures as not every P/S has experience/training with skin removal. Consultations are usually free to P/S to give you an idea of cost and recovery time; don't let the cost deter you from losing the weight. P/S now days may offer financing options, similar to those offered by orthodontists, to help patients pay for noncovered procedures.
Know I wish you the best in your endeavor to have the body you deserve. Please know Gastric Bypass is not a fast fix, as with any goal worth attaining, hard work and determination is required.
You seem to know a lot about this. Can you tell me if it's true that people are told to wait 1 year from the end of the majority of their weight loss as exercise (muscle tone) and other factors can change the skin during that next year? I attend a support group with people from many different programs and surgeons and everyone seems to have been told that what you have at the end of the first year or so can be very different at the end of 2 years so it's best to wait...except obviously in extreme cases.
We've been told that many cases that might be medically necessary are automatically rejected if you are within a 2 year window of your surgery.
Is that true?
Last edited by resolution09; 06-03-2011 at 11:39 AM.
Unfortunately, I am neither a physician nor an RN and not "medically" qualified to answer your question. Beyond that and this is key, each and every insurance company may have differing criteria to make the determination of what they "define" as medically necessary; this is why I referred the OP back to her insurance company. The initial question was whether insurance companies ever covered the removal of excess skin and the answer to that, was yes - sometimes. I could make a quess that the time frame (either one or two years) is to allow the patient to achieve maximum weightloss through diet and excercise before surgical intervention; and this is only a guess. This guess mirrors the criteria for approval of Gastric Bypass surgery which for many insurance plans, is only covered after the patient has participated in a supervised weightloss program for a specified time frame (usually 1 or 2 years). Logically a person with G/P pay lose in excess of 100 pounds; if the excess skin were removed, say, every 25 pounds, it would require 4 surgeries. Besides, no one wants to have surgery that can otherwise be avoided, no one wants to minimize the benefits of diet and excercise.
Nice post....Actually checked out your blog not too long ago. Very impressive. I ofcourse would rather be a lot lower with excess skin than still obese, I was just wondering if there was any known way to limit it.
In Gastric Bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine.
Most people can return to their normal activities in 3 to 5 weeks.
You may have to avoid foods that contain simple sugars-like candy, juices, ice cream, condiments, and soft drinks. Simple sugars may cause a problem called dumping syndrome. This happens because food moves too quickly through the stomach and intestines. It can cause shaking, sweating, dizziness, rapid heart rate, and often severe diarrhea.
I am new to this board but not new to gastric bypass. I would like to share with you what I have learned about the excess skin issue in the hopes that it may prove informative. Just like the poster from the insurance company, I am not a doctor and bottom line, the best place for any questions you may have would be your surgeon or plastic surgeon.
Having said that, I am 11 years post-op and was 34 at the time the time of surgery. I had already had two children as well as having been obese from very early childhood. I remember in kindergarten we all had to be measured and weighed. On that day, at the age of 5 I weighed 125lbs. I say this to say that my skin never enjoyed the luxury of a normal sized owner, only one very overweight so it of course was used to having to stretch. I had one drastic weightloss of 88lbs when I was in my 20's and going to a diet doctor. I must say that at that time I seemed to tighten up enough to where the difference was noticeable and didn't create a hanging skin issue. I wish I could say that about my gastric bypass LOL!
Also, my gastric bypass was my second weightloss surgery. I had the Vertical Banded Gastroplasty (stomach stapling) in 1997 at the age of 32 and lost another 80lbs within 6 months before my ring on my pouch just suddenly disappeared which rendered my surgery ineffective, the weight started coming back on and resulted in a revision to the gastric bypass.
My pre-op weight for the VBG was 320 and my lowest weight after gastric bypass was 160 so basically, between the two surgeries, I lost half of myself weightwise. In the process I developed hanging skin from the arms that in post-ops is known as batwings. My batwings were (are) impressive and I always say that if I were to launch myself off of a building I would be able to fly just by using them. To me, this is the worst area as it means that I must wear sleeves anytime I go out in public. This includes in 100 plus degree heat.
Another problem area is the tops of the thighs where the skin is wrinkly. Although it doesn't look good, it can be easily covered. Finally, there is the stomach area. On me, this area is horrible but still it is easier to disguise than the arms although it makes it difficult to run and creates back strain as well as rashes.
I did consult a plastic surgeon about removing the skin in the worst areas but they flat out told me that insurance never covers it and I would have to pay upfront then "if" they got paid once I filed my claim (they refused to even file they were so certain it was a waste of time) then I could be reimbursed. I left and never looked back.
In my research I have found that documentation of problems arising from excess skin is necessary to have it considered as reconstructive vs. cosmetic. In essense, I have seen suggestions to go to the doctor everytime you get a rash or lower back pain and to take pictures of the rashes. This is of course for the stomach and possibly breasts. I was told if I wanted arms done then I had to pay for that out of pocket (about $5K as I recall) then if insurance DID cover the stomach then that would cover the hospital, operating room, anesthesia, etc. and I would only have to pay for the surgeon's procedural price for the arms. Same for breasts or lower body lift if I wanted that.
I was told that they want you to have your weight stabilized for a year after you were no longer losing. The reason given is that of course the skin IS elastic so any gains and losses after the P/S would create more excess skin issues (although admittedly less than losing half of yourself in weight). Preganancy is discouraged after P/S for the same reason although that was no biggie for me.
Things that can play into how well your skin bounces back after surgery and during weightloss include but are not limited to: age at time of surgery, if you've been pregnant OR gained & lost substantial amounts of weight prior to surgery, how long you were morbidly obese, genetics, how well your body responds to excercise, committing to do cardio as well as toning excercises, drinking water and keeping your body hydrated inside and out. In other words, there are different variables that come into play and no one person is going to have the exact same results as another.
I hope this is helpful and informative from a layperson's POV. I apologize for the length of the post but wanted to share as many details as possible.