So I have had several people ask me “how do I go about getting that surgery?” So I’ll tell you what I did, and what the requirements are for most insurance companies (in the USA, anyway).
First of all, my weight had been an issue for years. Ever since I had children, my metabolism was slow and I could never seem to take off any weight. Admittedly, I was rather lazy and made poor food choices as well. So after a few years of my family doctor telling me I needed to lose weight, and me genuinely wanting to but never making progress, she referred me to a nutritionist. However, insurance didn’t cover a nutritionist. So I was sent to Surgical Associates in Grinnell, IA. That clinic specializes in bariatric/weight loss surgery, such as the gastric sleeve and gastric bypass surgeries. I wasn’t really interested in such a surgery, but decided if I couldn’t lose the weight with proper nutritional counseling, it may be something I would consider.
At Surgical Associates, there is this amazing nutritionist/nurse Stef Noun. She is the most upbeat, amazing weight loss cheerleader I have ever met. She was always so inspiring to me, and every visit I had with her made me that much more motivated to take off the weight. And since she was so encouraging, I never wanted to disappoint her. She taught me how to eat properly, for nutrition rather than just for pleasure. She taught me that I shouldn’t deprive myself of what I want, but I should use strict moderation. She helped me cut out soda, limit carbs, focus more on protein, and really set me on the right path for my nutrition. She also encouraged me to be more active, and always wanted to know my plans for diet and exercise at every visit, which was once per month. At those visits she also documented any issues I was having with my sagging fat and skin, such as rashes, headaches, back aches, and things such as those.
For most insurance companies, all it takes is 6-7 months of regular documentation of following nutritionist instructions and proving you can change your lifestyle (losing at least a little weight) to be accepted for bariatric surgery. I went ahead and submitted to insurance my request for the bariatric sleeve. I was approved. I refused the surgery because I thought I was doing pretty well without it. And within a few months I had lost too much weight to qualify anymore. I was able to use Stef’s tips and encouragement to lose the weight myself. I know that is not possible for everyone, and that is why there are programs such as theirs. My story just happens to be that I was able to lose it on my own.
Now, when it comes to the skin removal surgeries, most insurance only covers the Panniculectomy and Breast Reduction. The Panniculectomy is the removal of the pannus, or the skin beneath your belly button that hangs over your pubic bone and hip area. It does not include the repair of any muscle splitting from childbirth or obesity. In order to have either of those skin surgeries, you need to have a steady weight for at least 6 months, and 6-12 months of documented health concerns directly related to the sagging skin, such as rashes or skin infections. Once you have met those requirements, you’re eligible.
If any other skin removal surgery is desired, such as arms, thighs, back, buttocks… that’s up to you to pay for out-of-pocket.
And for those of you curious, I have state insurance – Medicaid, and it payed 100% for my Panniculectomy. I plan on having the breast reduction as well sometime in the next 6-12 months.
Disclaimer: this was MY experience. I’m sure insurance requirements and coverage can change at any given time. So be sure to check with your healthcare providers and insurance companies for the up-to-date requirements and coverage.