Wrong Doctor

This past weekend I received a page from a woman whom I’ll call Flora.  I didn’t recognize the name or phone number that I was given.  I called anyway and when she answered, it went like this.

Me:  “I’m Dr Ramona Bates.  You had me paged.” 

Flora:  “You removed some lesions from my face on Monday, and I’m having some pain.”

Me:  “Ma’am, I don’t know you.  Are you sure you have the right doctor?”  I know confusion is audible in my voice as I’m going back over my schedule for the week in my mind.  I recall the procedures I did and there were no facial patients at all for the week.

Flora:  “I’m looking for Dr Bates.”

Me:  “Which Dr Bates?”

Flora:  “Dr Ramona Bates.”

Me:  “Well, that’s me, but I didn’t remove any facial lesions for anyone this week.  Are you sure a Dr Bates did your surgery?”

Flora:  “I’ll get my paperwork out and call you back.”

 

I never got re-paged, so hopefully Flora got the name of her doctor off her paperwork and called the right one.

Patient Question – Options for Payment/Coverage of Surgery

 Updated 3/2017 -- all links (except to my own posts) removed as many no longer active and it was easier than checking each one.

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). 

Patient Skin Care Questions

I recently received any e-mail from a reader

I found your blog while searching for information on the panniculectomy procedure... thank you for your clear differentiation on this procedure versus a tummy tuck! The pictures gave me the aha moment.   :)

…... I have not had WLS, but instead have worked at life-style changes. …..So here I am now, roughly 100 pounds down with +/- 70 pounds to go... no insurance coverage and many skin issues to deal with - some cosmetic, but most necessary to prevent the awful skin irritation………. Surgery is cost prohibitive, but lack of surgery leaves us feeling sub-human. There has to be an answer to this - I just must not be Googling it right :p

I do have a couple of questions if you could take the time to answer them... perhaps you would consider placing them on your blog page……. 

 

Here are her questions (rephrased slightly) and then my answers:

Q1.  Have you come across compression garments that keep the pannus elevated without being miserable to wear?

• Depending on body type (apple or pear shape for example) this can be difficult to find.  The best advice I can give you is to measure yourself at the waist, across the largest part of the pannus, and beneath the pannus (hips).  You may find (and I realize this may be embarrassing) that the best fitting girdle may be one designed for a pregnant woman.
• Compare your measurements with the manufacturer’s size chart.  Very often it won’t be clear which size is the one for you.  I would (if possible) try on the one which fits closest to your pannus measurement and also the one which fits the hip measurement.  If the first feels too loose and the later too tight, try the size in-between.
• Try both panty girdles (medium to heavy grade, as the elastic will last better) and one-piece bra/girdle combinations.  It will be a matter of trial and error, as it is with most clothes.  You will need to try them on.

Q2.  I have very thin skin - where the stretch marks are from the weight gain and pregnancy.  I always worry about the skin tearing because it is  so thin.

• This is a very real issue and the skin can tear from the forces exerted on it – ie the weight of the pannus.  Make sure you let your family doctor or dermatologist know when this happens as the documentation of this may help you get your insurance company to pay for the panniculectomy.  This becomes a medical issue not a cosmetic one.  You want it to be documented in your physician’s chart.
• Prevention of the tearing comes down to reducing the weight or the pull of the pannus on your skin.  If you can find a decent girdle that is comfortable enough to wear, this can help. 
• Also, babying the skin with non-perfumed, non-alcohol based lotions that won’t irritate or excessively dry the skin will help.  Try using Gold Bond ointment or Aquaphor or A&D ointments.
• Once the skin tears, it becomes a matter of wound care to prevent infection and allow healing.

Q3.  I get this horrible red rash or skin irritation under the skin fold and on the corresponding skin it is touching.  It's debilitating, humiliating, and results in an embarrassing odorous discharge.  I have the same issue under the breasts and with my thighs.

• I have had patients tell me that using deodorant (roll on) in the skin fold to decrease sweating helps. 
• Wearing clothing that helps prevent the skin to skin contact helps.  For example, the girdle you asked about above.  Finding a well fitting bra that supports the breasts up and away from resting on the chest skin.
• Good skin care as in the previous question/answer.

 

Ultimately there are no simple answers to your questions I’m sorry to say.  I would encourage you to document any skin tearing and/or rashes and/or skin infections you get.  This documentation can help in getting any excess skin excision surgery done in the future classified as reconstructive rather than simply cosmetic.

Lastly, and maybe most importantly, may I commend you on changing your life style so that you have lost the weight.  I hope you continue to do stick to it.  Thank you for your kind words.

 

Other posts that you may find interesting:

Panniculectomy vs Abdominoplasty

Insurance and Healthcare Thoughts

Tips for Finding a Good Bra Fit