Insurance Woes

Insurance Woes

When I was in my 20s, I had a doctor who took a long look at my belly and said, “You’ll need surgery for that.” Stunned, I said nothing. How dare she assume I’d ever have cosmetic surgery? She barely knew me! Did I like my fuller lower tummy? Of course not. But I wasn’t about to undergo elective surgery to lop it off. Especially given all of the previous surgeries I HAD to have (such as three GI resections). 

When I was in my 30s, I became pregnant. I willed that lower tummy to be absorbed into the baby belly, but it never happened. I never had that cute bump most women have. I just got ginormous boobs and looked fat(ter than I was). But, that wasn’t so important. Having a beautiful, healthy baby was my biggest priority. So much so that as I moved through motherhood, I began to gain more weight (reaching over 220 lbs on my 4’9.5″ frame), and that lower belly grew even more prominent.

Fast forward to the present, when CrossFit and counting macros has led me to a 40 pound loss over a few years. Even after losing all of that weight, I felt my boobs were still too big. Not only did they make me look bigger than I felt when looking in the mirror, they were still super heavy, and I continued to have back and shoulder pain from the industrial bras necessary to keep them supported. This is why I decided it was time for a reduction. Once insurance approved it, I got even more serious about sticking to my macros and losing weight. After all, the closer I am to my “goal weight” (an arbitrary number), the better my surgical results will ultimately be. And bam, in just a few months, I lost about 10 more pounds!

Of course, all of that weight loss did not make my belly flat. That doc from years ago was right. I’d need surgery to fix it. Sure, it got smaller, but it also hung longer, hitting my thighs in parts, bouncing and making lovely fart sounds when I ran. Plus, I had chronic intertrigo (rash in body folds) both under the panniculus (fat apron) as well as my breasts. Weight loss alone was not going to relieve these problems. So, back to Dr. Geldner I went, and we submitted more images to insurance for approval. Initially, the procedure on my belly was denied (they said it did not hang low enough), but with supporting documentation from my dermatologist and a peer-to-peer discussion between Dr. Geldner and the insurance doc, we got a portion of that decision reversed, and the panniculectomy (removal of the remaining lower belly fat and skin apron) was approved (we would pay out of pocket for the upper belly abdominoplasty needed to give the best cosmetic result).

The surgery was set for April 16th and Hot Deb Summer was on the horizon! I continued my buckled down dietary ways, only straying on our spring break cruise. I’d gained 3 lbs that week, but managed to lose that plus a few more for a total of 56 lbs lost since I began this process in 2019. 

One important note: I would never have opted for any of this surgery if I had any doubts that I could keep the weight off and not end up right back where I was. Over the years, I’ve tried so many different exercise and weight loss programs, only to yo-yo on the scale. However, tracking macros and CrossFit have led to a real change in lifestyle. I love feeling strong and physically capable of so much, but even more than that, I enjoy eating to fuel my body as opposed to eating for short term pleasure. I am fully confident that if I decide to let it go for a week or so, like I did on the cruise, I have the tools to correct course and not let it get out of hand.

Once we got back from that spring break cruise, it was T-minus two weeks until makeover day.  I had a pre-op primary care appointment and surgeon appointment, and then all I had to do was show up on the 16th and let Dr. Geldner work his magic. But we hit a snag. At my pre-op appointment with Dr. Geldner, because I’d lost more weight since the last visit, we had to re-do photos. It was then that he started to question the insurance approval. He could not understand how the breast reduction got approved because according to that Schnur Scale, I didn’t have the volume typically required. In fact, he did not even provide the tissue volume information to the insurance company.

He did not want it to be denied after the fact, leading to me being slapped with a five figure bill, because that is not how he does things (which I very much appreciated). So, they resubmitted the request for approval. While I valued his due diligence, I was not happy having to wait and hear if we would, indeed, be able to give the girls a trim. I was determined to be optimistic, hoping that because we have ridiculously good insurance through Hubs’ employer, our plan did not require that silly, man-determined volume removal. A few days before surgery, I even called BCBS myself to find out what was going on, and learned that they were, indeed, waiting for that additional volume information. It was then that I had to come to terms with the fact that the boobs were not going to be done. At least, not at this time. I only cried a little bit. 

I don’t know that I ever would have pursued the panniculectomy and abdominoplasty (tummy tuck) if I wasn’t having the breast reduction too, but here we are. And I’m keeping my fingers crossed for the insurance company to send down a miracle.

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