Wednesday, November 12, 2008

Patient Question – Options for Payment/Coverage of Surgery

The same person who asked the questions here, had more questions regarding how to pay for (self/insurance) procedures that remove the excess skin after weight loss.

 

Insurance Coverage

If you are “lucky” then you have insurance coverage, but as I wrote about here that is not likely.  For most (hesitate to say all, as I have not read all policy booklets), define cosmetic surgery this way:

Cosmetic Procedures -- services are considered Cosmetic Procedures when they improve appearance without making an organ or body part work better. The fact that a person may suffer psychological consequences from the impairment does not classify surgery and other procedures done to relieve such consequences as a reconstructive procedure."

So without a medical reason (ie major skin issues, repeated infections, such a large pannus that it interferes with mobility, etc) then the surgery to remove skin from the abdomen, arms, breasts, etc will always be defined as cosmetic.   If you have any of those medical issues, be sure you have them documented by your family physician or surgeon who did your lap band or gastric bypass.  It’s not enough for you to simply say, you have had the skin issues and dealt with them yourself for five years.  That won’t help me help you get coverage.  I can not say it enough, make sure it is documented.

 

Indigent Care Coverage

Most states have a program similar to Colorado’s (pdf file)

The state does not have sufficient resources to pay for all medical expenses for persons who are indigent.

The state must allocate available resources in order to increase access to primary care among Colorado’s indigent population.

So once again, you will need to prove that it is a medically necessary issue that the surgery will improve or correct.  If it is, there will need to be documentation.

 

Medical Schools / Residency Programs

There are no programs that I know of or could find with a google search that allows it’s plastic surgery residents (USA) to perform reduced fee or free surgery just for the training.  If anyone knows differently, please, let me know.

 

Credit/Financing

Physicians and hospitals take most credit cards these days.

Then there are many companies out there that will gladly loan you money with different interest rates and 1-5 yr pay back plans.   A few of them include:

Capital One Healthcare Finance

Care Credit

Med Loan Finance

Reliance Finance Company

Surgery Refinancing

 

Medical Tourism

Not one I really want to advocate, but it is an option.  It is well known that the cost of surgical procedures in other countries is much less than in the United States.  However, please, be very careful if you take this route.

 

 

 

When you have multiple procedures you need or want to have done, it will often be necessary to stage them for your own health safety (for reasons such as length of surgery, estimated blood loss, etc).  So if you can only pay for one procedure, which would it be.  That in my humble procedure is often the place to start.  It is not always the same place we (patient and I) would start, if there are no issues with money (none of my patients fall in this category). 

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