Advice on Insurance Coverage for Skin Removal After Weight Loss

Hello all!

Anyone have to fight insurance to cover excess skin removal in the abdomen? I Need some advice.
I have had an ileostomy since 2012. I had always been morbidly obese and eventually ended up with a large hernia and then large pressure ulcers. My GI doctor and plastic surgeon told me a large weight loss would help in many ways but hernia repair, stoma relocation and excess skin removal was my best option for long term success.

Over two years I lost 125 pounds. I now have large amounts of hanging skin. My insurance (Cigna) refused the skin removal and initially denied and then approved moving the stoma. I went ahead and had the stoma moved and the hernia fixed due to the chance of the small intestine twisting and a large, bleeding, painful ulcer that could not be healed. 

My skin is extremely wrinkled and has absolutely no firmness. The surgical result is now a recessed stoma, buried at least an inch under the skin line, a bag that hangs much lower than normal and a week post op, lots of leaks and skin breakdown already  I’m beside myself. Any advice on fighting the insurance?

Thanks in advance. 

traci

Oh my gosh, Traci, as wonderful as your weight loss is, I'm sorry that it's interfering with your ostomy appliance. It sounds to me that, because this whole journey of yours was encouraged by your GI and plastic surgeon, they should be fighting on your behalf by contacting your insurance company and emphasizing how your excess skin removal is medically necessary. You shouldn't have to advocate for yourself alone in this.

I have 5 years of experience with a colostomy. I have a concave stoma site. I was helped by an ostomy nurse to get a fit. Marlen is the only company that has a deep convex pouch I have been able to use. I also have to do a build up with more below the stoma and extra on each side. I recently had a parastomal hernia repair and the size of the stoma has changed. I have sealed boxes of 3½" and 3¼" stoma size that I can't use. Is there any way someone might be able to try them? (I don't know the rules.) 

Due to many reasons related to the local university hospital, which has a world-renowned research center with vast resources and technology, the quality of doctors, and the rest, they could not figure out why I would develop abdominal infections. That went away on its own, but not before I experienced the private hospital system. When they do not understand something, their reactions and more are concerning. So, I got a lawyer. The plan was not to file a lawsuit but to get them to first pay attention and second, change their quality of treatment. For a low investment, I got a young lawyer to write some letters. It worked. If your city has a free legal clinic, you can find out much information without having to pay a penny. I learned much in these places before I decided on a strategy and found a lawyer. Also, here senior centers are super active; the culture here is highly social and interactive, so these places offer great legal advice. I paid only $45 for a membership and spoke with a lawyer about my rights for free, a very qualified female lawyer with a warm approach. They have great classes also, and activities.

After this experience, I have very low faith in hospitals dealing with unusual cases such as yours. It was like hitting a brick wall, and then there was indifference, which is the worst due to inaction; I had to do something and at some point figured they were not going to listen and took a different approach. Not saying that this approach is recommendable because it establishes a different relationship with the doctors and care which, in this case being a huge medical system, is okay; they're big fellas.

I'm not sure this would work in a small community and hospital where everyone knows everyone. I'm simply throwing it out there; it may work for someone, you never know. Everything worked in my favor, met the lawyer through an acquaintance of a close friend, and we're all alumni from the same local university, but before that, I learned tons with this free legal assistance. Not sure it would work under other circumstances or even recommendable, but it's worth a thought.