After weight loss surgery, what plastic surgery procedures will be covered by Healthfirst?

Congrats on your weight loss. I do not know anything about Healthfirst, but can give you some general guidelines. Some of my body contouring patients who have had a massive weight loss whether through diet or surgery get limited help with any more surgery. Sometimes we have gotten all or some of their panneculectomy/tummy tuck covered by insurance. Rarely have we gotten any coverage for breast, arm, thigh,  or buttock shaping procedures since this is usually ruled cosmetic. Make an appointment with a plastic surgeon who does a lot of body contouring and they can help you with your decisions. Good luck.

Thank you for your question regarding insurance coverage
after gastric sleeve surgery. Unfortunately your question is a difficult one to
answer. Each insurance policy has their own list of criteria. Even within the
insurance plan, there are multiple tiers. I have seen the same insurance
company approve one patient for reconstructive plastic surgery and deny the
another. This situation was in patients
with similar body builds, but they had different levels of insurance within the
same insurance company. To make it even more confusing, medical
insurance plans differ from one state to another.

On the one hand, some insurance plans categorically deny any
reconstructive plastic surgery after massive weight loss or gastric surgery. On
the other hand, some insurance companies are generous and cover 360
circumferential lower body lift, medial thigh lifts, breast lift, breast
reduction, and arm lifts.

My advice to you is that I would suggest you seek a
board-certified plastic surgeon with extensive experience in reconstructive
surgery after massive weight loss. I would also seek a plastic surgeon who works
with insurance companies and weight loss patients. I would document and take
pictures of any rashes or skin conditions you have. These will be important
when submitting to insurance. Insurance companies need to see that you have
significant difficulties keeping skin areas clean. For insurance approval, they
often need proof that these skin areas have been refractory to topical creams.
You may need to see your family doctor or dermatologist to have these skin
conditions initially treated.

After you have tried to treat your rashes conservatively, I
would collect your documentation and photos.
Then, I would seek out a plastic surgeon. If your plastic surgeon determines
you are a good candidate, he or she will submit your claim to the insurance
company. Once your application goes to
the insurance company for authorization, it is up to the insurance company to
decide if they are going to approve your surgery. Hopefully, a board-certified plastic surgeon with
in the insurance company will review your submission for surgery. Hopefully,
your surgery will be approved. If your
authorization for surgery is denied, I would suggest asking the insurance
company why your surgery was denied. If you can prove that the denial is
unfounded, then I would suggest reapplying. If not, I would move on. Often, you
can switch to a better insurance plan, which may cover your proposed
procedures.

Unfortunately, most medical insurance plans are trending to
have less and less coverage for reconstructive plastic surgery after massive
weight loss. If you have any questions regarding insurance policies for surgery
after massive weight loss, please contact my office. Good luck! Sincerely, Dr. Katzen