Sorry if this might bring us too OT, but I know that when she and amber were considering weight loss surgery, they didnt seriously commit in terms of losing the weight and listening to doctors orders...
if someone their size lost the weight, how involved or complicated is excess skin removal surgery? What's required prior to? Would it be considered cosmetic or necessary?
Im not going to name my former, future, or current career, but I’m very familiar with process for panniculectomy surgeries. (In the US, atleast)
Nearly all BCBS, Humana, UHC, and other large insurance plans will automatically approve a panniculectomy surgery after dramatic weight loss if the doctor diagnoses the patient with back issues caused by excess skin or any issues that can cause a major health risk/shorten length of life (such as compressing of the lungs, a large open wound being present, a hernia that can be affected by the skin drooping, or weighing on the heart). They typically require pictures to be documented as well, but they’re approved generally instantly/quickly.
However if it’s not a life-threatening/very painful issue, it’s not marked as urgent for a quick decision. A case is opened and all doctors notes, photographs, and any records of therapies attempted must be sent to the insurer to determine on a case-by-case basis. The precerter will give all diagnosis codes to the insurer to determine if surgery would improve quality of life beyond a cosmetic change. Surgery could be approved in as little as a week, though in many cases it’s denied. The insurer will instead approve 5-30 units (visits) to physical therapists, dieticians (yes, to lose even more weight first), and other alternatives. Once these are followed through, there can be a stronger case made to the insurer that the skin is causing significant discomfort/risks/issues and isn’t solely a cosmetic issue. This round: the doctor, nurses, referral managers, and precerters include as much information and diagnoses as they can to get the insurer to approve it. If this is also denied, the final step is for the doctor to do what’s called a peer-to-peer call with a doctor from the insurer to make a final case if the doctor strongly believes the panniculectomy is medical necessary.
Though if your on Medicaid: it will typically be months before any approval. Schedulers are aware of this and generally schedule the surgery at least 3 months out. Medicaid in most states always deny the first time it seems. I’ve seen them deny people with massive open wounds that wouldn’t heal due to the skin sag. Medicare is generally the opposite.