Covered By Insurance


The benefits of septoplasty, a procedure that straightens the curved septum or wall of tissue between the nostrils, are beyond cosmetic. Basically, it eliminates nasal blockage, which in turn leads to improved breathing and immediate relief from snoring, sleep apnea, chronic sinus, recurrent headaches, and frequent nosebleed.

 

Some cases, the benefits of septoplasty can be lifesaving, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.

 

On his recent Snapchat video post, the surgeon has explained that during sleep, the heart needs to rest, which can be impossible if it does not take enough oxygen due to poor breathing functions caused by the deviated or curved septum. Over time, its chambers become enlarged and may lead to its failure, hypertension, and pulmonary edema.

 

Because of the detrimental effects of deviated septum, Dr. Smiley said it is generally considered as a medical condition and thus many patients can ask for insurance coverage.

 

One particular patient of the celebrity plastic surgeon has significant nasal obstruction, with her right nostril almost completely blocked because of the deviated septum and the enlarged turbinates (they are small protrusions that keep the air warm and moist).

 

benefits of septoplasty

 

The turbinates actually accounted for about 90 percent of the nasal obstruction. Hence, Dr. Smiley removed them along with the deviated septum whose mucosa lining was then sutured in the midline.

 

Instead of forcing the deviated septum into a midline position, sometimes it is better to remove it completely and then suture the mucosa lining draping over it to make the “wall” between the nostrils straighter.

 

The problem with forcing the deviated septum in the midline is the tendency to spring back into its previous position due to its “strong memory.”

 

It is important to note that septoplasty, with or without turbinate reduction, does not improve the outside appearance of the nose. Nevertheless, it can be combined with rhinoplasty, or more commonly referred to as nose job.

 

Should there is a desire to improve the outside appearance of the nose at the same time as septoplasty, it actually makes sense to do them together than separately, as it allows the surgeon to re-use the septum to further refine and reinforce the new contour.

 

By using the septal cartilage, the patient avoids synthetic implants and their associated risks such as protrusion, visibility, and less than natural results.

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Sleeve gastric surgery is believed to be one of the safest weight loss surgeries since it does not leave foreign object or implant in the body nor involve rerouting or changing stomach openings.

 

Due to the technique’s impressive safety profile, renowned Beverly Hills surgeon Dr. Tarick Smiley prefers this technique to other weight loss surgeries.

 

sleeve gastric surgery

In his recent Snapchat video, Dr. Smiley says sleeve gastric surgery can reduce the size of the stomach by around 60 percent, making this an effective tool in controlling hunger without causing the same side effects of malabsorptive-type weight loss surgery.

 

Despite the benefits of sleeve gastric surgery, its long-term results will still primarily depend on the person’s commitment to lead a healthier lifestyle—i.e., proper diet (three small meals that are low in carb and high in protein everyday) and regular exercise. For this reason, the real challenge is identifying patients who can stick to their weight management program.

 

Studies have suggested that sleeve gastric surgery removes the part of the stomach that releases most of the hunger-producing hormone called ghrelin, leading to its high success rate. Medical evidence shows that patients lose 45-64 percent of their excess body weight just a year after surgery.

 

Because of the lower complication rate of “sleeves” compared with other weight loss surgeries, Dr. Smiley says it is suitable for individuals who have risk factors such as osteoporosis, anemia, and complex medical conditions.

 

Unlike malabsorptive weight loss surgeries (e.g., gastric bypass) in which the intestine is shortened, during a sleeve procedure the openings are left intact and the normal functions of digestion are mostly preserved. For this reason, there is a lower risk of malnutrition and its subsequent complications such as anemia and osteoporosis.

 

While the procedure is irreversible, the significantly reduced stomach may expand over time with poor diet, hence leading to gain weight. For this reason its success greatly lies in the patient’s determination to stick to healthy lifestyle long term; this is possible through support from his/her family, friends, and doctors.

 

Behavioral therapy may also help in preventing weight gain recurrence by changing how the patients’ think about themselves and to help them identify the environments and circumstances that are linked to their unhealthy eating and other poor lifestyle choices.

 

Obese patients who have sleeve gastric surgery and other weight loss surgeries are less likely to die from cancer, diabetes, heart diseases, and other obesity-related medical conditions than those who forego the procedure, as suggested by several studies.

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Panniculectomy cost is oftentimes covered by health insurance, although the patient must be able to demonstrate that it is a medically necessary procedure, as opposed to a cosmetic surgery.

To get a pre-approval, the patient must present medical evidence and doctor’s recommendation letter suggesting that the hanging, apron-like skin is causing non-healing irritation, mobility issue, poor hygiene and foul odor, and/or back pain due to its extra weight.

panniculectomy cost

Board-certified plastic surgeons who focus on body lift after weight loss generally have staff who are familiar with the insurance process.

Should the patient’s claims are rejected, she can appeal and possibly provide additional medical proof suggesting that her panniculectomy is a reconstructive procedure in which the main goal is to improve her body function, as opposed to physical appearance.

According to California Surgical Institute website, the most common reasons for denials are lack of physical and lab tests, incomplete insurance information, and diagnosis error.

Insurance coverage is very helpful because the average panniculectomy cost is $8,000-$12,000. In some cases it covers the entire amount, although one survey has suggested that many patients-policyholders should expect at least $300-$500 out-of-pocket expenses.

Just like a tummy tuck, panniculectomy also uses a hip to hip incision to remove the apron-like hanging skin. However, there are key differences between the two procedures.

While both procedures results in a hip to hip scar, panniculectomy is primarily designed to remove a large flap of redundant skin and fat caused by massive weight loss. Tummy tuck, meanwhile, focuses on its cosmetic component: To create a slender waistline and flat abdomen.

Tummy tuck provides more contouring than panniculectomy because aside from removing the excess skin and fat, it also tightens the abdominal muscle that has been stretched due to pregnancy or weight loss.

But unlike panniculectomy, tummy tuck is generally categorized as a cosmetic surgery and therefore rarely covered by health insurance.

Sometimes, panniculectomy is combined with other procedures such as tummy tuck (for muscle repair) and liposuction (fat removal), leading to a more balanced appearance. However, the cosmetic components of the surgery will not be covered by health insurance.

While it is always ideal to have panniculectomy only when the patient has achieved her weight goal, sometimes it is performed even though more weight loss is expected if the redundant skin is causing a lot of discomfort.

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Breast reduction insurance requirements differ from issuer to issuer, although many of them demand large reductions (e.g., from F cup to C cup) and take into account the patient’s weight and height and her previous effort to try non-surgical alternatives such as weight loss and physical therapy.

Upland plastic surgery experts share their tips on how to increase the chance of getting pre-approval for breast reduction.

1. breast reduction insurance tipsWork with a qualified plastic surgeon whose staff is familiar with the insurance process. They can help you secure all the medical evidence and recommendation letters from experts suggesting that you need breast reduction to improve body functions instead of appearance.

2.  Know your goals. If your main goal is to find relief from back and shoulder pain, spinal curvature, and systemic discomfort caused by overlarge, heavy breasts, there is a good chance that you’ll enjoy breast reduction insurance.

3.  Read the fine prints of your insurance. Issuers have different prerequisites, with some being highly restrictive that they deter some patients who actually need breast reduction to improve the quality of their lives.

Some insurance will only pay if breast reduction involves the removal of at least 500 grams of tissue from each breast (much to the disadvantage of petite women), while others consider the patient’s height and weight, a method that is more favorable to women.

Should your insurance require a strict “amount” of removed tissue, don’t be forced to accept a postop size that is too small for your liking just to get coverage.

4.  Try non-surgical alternatives. Some insurance issuers require patients to first try non-surgical procedures such as physical therapy if their main complaints are back pain and rounded shoulders. But some doctors feel that such requirement shows that companies will try every effort to deter patients or postpone paying for breast reduction.

Weight loss is another common prerequisite. However, there is one major caveat: achieving your ideal weight is hard, if not painful, because the overlarge and heavy breasts make exercising quite a challenge.

5.  Ask for experts’ recommendations and letters. Your medical evidence will include letters from orthopedic surgeon, plastic surgeon, internist, and/or chiropractor. The main goal is to prove that breast reduction will eliminate physical discomfort caused by having an overlarge cup size.

6.  Know that you have the right to make an appeal if your claim is denied. While it may be disheartening at first, bear in mind that you can always demand an appeal, especially if you know that your surgery is medically necessary.

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Most factors linked to sleeve gastrectomy complications can be avoided or at least minimized through proper patient selection, lifestyle change, and postop support and counseling.

Sleeve gastrectomy is a type of restrictive bariatric surgery in which the stomach is reduced to about one-fourth of its original size, so the patient will feel full a lot quicker than he is used to even with a small amount of food.

sleeve gastrectomy complications

But as with any type of weight loss surgery, the procedure is not a quick-fix solution for obesity.

The list below explains who to avoid sleeve gastrectomy complications and maintain a healthy weight long term.

  • Lose as much weight as possible prior to surgery. Studies have shown a strong link between obesity-related problems and high rate of complications in the first six months postop.

All efforts must be made to treat or at least control high blood pressure, sleep apnea, arthritis, diabetes, and deep vein thrombosis, which are all tied to unhealthy weight.

  • Stick to a healthy diet even months before surgery. Nutritional support and counseling plays a crucial role in the success rate of weight loss surgery. The general rule of thumb is to eat more fresh produce and lean meat, and avoid highly processed foods that are typically high in sugar and sodium.

Proper diet is more crucial after surgery to avoid leaks (and other similar complications) caused by over-eating and drinking carbonated sodas, resulting in stomach expanding and stretching.

  • Have a reasonable exercise regimen. This is an indispensable aspect of a healthy lifestyle. Also, gaining more muscle mass can improve the metabolic rate, which is important in long-term weight management.
  • Behavior modification. While the “ideal” techniques differ from patient to patient, the goal remains the same: help them focus on sticking to a healthy lifestyle and changing how they view themselves, the “food,” and their environment.
  • Close monitoring after surgery. The first two weeks postop is believed to be the riskiest stage, so the patients having this procedure far from their home must stay within the vicinity for at least 10 days (or ideally longer).

To maintain the results of sleeve gastrectomy, long-term weight management, of course with the help of doctors and other specialists, is extremely important.

  • Choose a highly experienced surgeon. Surveys have found a strong link between low rate of serious complications and high number of surgeries performed by a doctor.
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Nowadays, the criteria for plastic surgery insurance are becoming stricter that getting pre-approval has become an arduous journey for most patients.

However, plastic surgeons often have patient support staff who can help people navigate the murky waters of health insurance claims, which require comprehensive medical evidence and lab results suggesting that their surgery is medically warranted and not just for cosmetic improvement.

plastic-surgery-insurance

Photo credit: Stuart Miles at FreeDigitalPhotos.net

Los Angeles plastic surgery expert Dr. Tarick Smaili explains the ramifications of plastic surgery insurance.

  1. Read the fine print

Prudent policyholders will read the coverage details and contact the issuers’ customer service to obtain all the pertinent information. They should particularly look at the fine print or “inconspicuous” details that may prove unfavorable to them.

  1. Consultation with a board-certified plastic surgeon

Some patients choose to begin the “process” through a consultation with a board-certified plastic surgeon who can write a recommendation letter to the insurance issuers. Medical evidence and supporting pictures can also help them build their case.

  1. Try non-surgical treatments prior to approval

It is not an uncommon practice among health insurance carriers to require policyholders to try non-surgical treatments—e.g., physical therapy, weight loss, lifestyle change, etc.—before they consider approving their claims.

For instance, women seeking breast reduction to find relief from back pain and other similar symptoms are often required first to lose their excess weight (if they are overweight) or try physical therapy. If these treatments failed, this is the only time their issuers may consider covering the cost of surgery.

  1. Some surgeons do not accept insurance

Not all surgeons accept insurance, and not all insurance carriers will cover the cost of plastic surgery even if its nature is reconstructive—i.e., aims to improve body functions and address physical symptoms.

  1. The choice of facility might be limited

Insurance issuers will only pay for the surgery’s cost if it will be conducted in one of the accredited surgical facilities they have a tie-up with. This might be a problem for someone who lives far away from the vicinity where his operation will be performed.

  1. Co-payment is a common practice

Because insurers rarely cover the entire cost of surgery, anyone seeking plastic surgery insurance should always consider some out-of-pocket expenses.

Many insurers also have limitations on the number of days of inpatient rehabilitation/hospital stay, equipment, or service use. For this reason, co-payments should always be included in the computation.

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