After watching the July 16th show, we were flabbergasted that the insurance company turned Kim down for the skin removal.When will we get to the point that doctors get to decide if an operation is medically necessary or if it is cosmetic? We would like to start a fund so we can contribute to get money to pay for Kim's operation. If we would get everyone who watched the show to give a little it would add up to enough for Kim to get the operation she so desperately needs. Kim has worked hard and has a great attitude and deserves to move forward in her life. Is anybody else interested in donating?

I know that several other people on another internet forum mentioned the same thing. I would do it.

It really is a shame the hospital won't do it pro-bono. I wonder if they are afraid that would become public news/put on the show and then others would be screaming for the same.

I also wonder if any amount of letter writing to the hospital administrators would be of benefit.

There would have to be some sort of secured trust fund set up on her behalf by people that those in the internet community could be reasurred that their money was being used for the intended purpose.

There would have to be some sort of secured trust fund set up on her behalf by people that those in the internet community could be reasurred that their money was being used for the intended purpose.[/QUOTE]

I would do it if it were a secured trust fund that only Big D and Lil' D had rights to.

OMG! I cannot begin to tell you how overwhelmed and touched I am by the amazing posts on this forum as well as the OH website! The generous spirit of everyone is just...well, beyond words. I have felt so much love and concern from everyone...it's a wonderful thing!

I have just gotten good news regarding the skin on the belly, and I'm scheduled to have it taken care of in September! Once I am sure of details, I will post more information here. I'm sure there will be another battle down the road for the arms, breasts, back and thighs, but for now, one battle is done.

Please keep me in your thoughts and prayers. I'm sure my continued journey will be chronicled in the second season of Big Medicine, so all of you who have been so kind and amazing to me will be able to see how things progress.

Again, thank you SO much for your wonderful, supportive posts and emails! They have been just fantastic, and your support will help me as I continue this journey!

That's great news!! I'd love to hear the details of what happened.

One step at a time. What a good thing!

KIM!!! That's fabulous news. I just posted a note to you under a separate thread (haven't seen it show up yet). I feel SO much better knowing the insurance company has come to their senses regarding your pannus. There actually IS some justice in the world... even if you do have to fight for it!

I wish you nothing but continued success with all this! You're going to be a new woman when it's all said and done.

Congratulations!!
Judy

P.S. I live in Texas too (Dallas)... if you need someone to come sit with you and hold your hand... I'll do it!

I knew it would happen somehow! I'm so excited for you! I hope the surgery goes well, without complications.

Thank you so much! You have no idea how much I appreciate the overwhelming support that you all have given to me! I'm excited about surgery, even though it also makes me nervous, as any surgery would. I have started a blog on the Obesity Help website, and I will try to keep it current with how things are going.

Thank you, thank you! You all are great!

Kim, that's great news about your surgery. I know it will all happen for you eventually.

We can't blame the hospital. I'm guessing they do several pro bono cases, but for some reason couldn't take on Kim's case. As someone pointed out, it's not just the surgeons' pay - it's all the hospital staff, medication, etc. that adds up. Most nurses and anesthesiologists can't afford to work for free. And the hospital would have to dig into its "spare change" to pay them.

Kim this is great. I posted the other thread about using the last name. I think it's wonderful that you are doing this to help others. I was just concerned for the patients' privacy.
Best of luck with your tummy tuck. I hope to be right behind you. And Judy Boom you are a doll. Everyone needs hand holding. Kim, I will give you a spiritual hand holding in New York.

quote:

Originally posted by kvalera:
OMG! I cannot begin to tell you how overwhelmed and touched I am by the amazing posts on this forum as well as the OH website! The generous spirit of everyone is just...well, beyond words. I have felt so much love and concern from everyone...it's a wonderful thing!

I have just gotten good news regarding the skin on the belly, and I'm scheduled to have it taken care of in September! Once I am sure of details, I will post more information here. I'm sure there will be another battle down the road for the arms, breasts, back and thighs, but for now, one battle is done.

Please keep me in your thoughts and prayers. I'm sure my continued journey will be chronicled in the second season of Big Medicine, so all of you who have been so kind and amazing to me will be able to see how things progress.

Again, thank you SO much for your wonderful, supportive posts and emails! They have been just fantastic, and your support will help me as I continue this journey!

God is sooooo good!! I am so happy for you Kim! Not to be nosey, but did your insurance decide that they would cover you after all?

junkie, as far as I'm concerned, it's not being nosey at all...it's helping each other work their way through insurance mazes. The insurance company did reverse their decision and decided to cover the procedure after all. Yea!

I hope it is a bit easier to get the arms, breasts, back and thighs covered! LOL!

Kim, I'm so glad you're getting the surgery. I'm a frequent poster on OH and I'll look for your updates there. My insurance didn't cover my RNY (I had some inheritance money and was able to pay for it), and I'm sure they wouldn't cover PS either. They sure expect me to pay their high premiums though.

Kim, Good for you! That is indeed good news...congrats and I know that all will go well for you.
You're right....one step at a time, and you truly are in my thoughts and prayers, I'll bet September can't come fast enough for you.

I was coming in here to find out if there was some fundraiser set up so you could get your surgery, Kim. I was outraged that the insurance company would consider that cosmetic. I hate insurance companies... don't get me started!

I'm so proud of you for all your hard work and am very happy that you're getting the plastic surgery after all!

Congrats!

Wanda, don't give up on the idea of insurance covering plastics. There are ways to get things covered, you just have to learn to "play their game" and play it better than they do. I'm happy to share tips I'm learning if you think they may help you.

Rustic, you have no idea how much I appreciate the support! It is amazing to have that much concern from people I've not even met! All of the people who have posted have been unbelievably supportive and kind, and it has really been a tremendous help to me!

quote:

Originally posted by kvalera:

Wanda, don't give up on the idea of insurance covering plastics. There are ways to get things covered, you just have to learn to "play their game" and play it better than they do. I'm happy to share tips I'm learning if you think they may help you.

Kim, I think that’s a great way to look at things. It is really a game and either you play it or it plays you. I’m happy to hear that this procedure will be covered. Best of luck.

Kim- I have sent you an e-mail. Good Luck, I have lived your story, thanks for helping others through the show and here on the boards. Having the extra skin removed (I lost over 200 pounds and another 27 of skin and tissue with plastics) is a great reward to all the hard work! Good Luck

Kim, I am so happy for you. When I saw the show the other night I was so upset but God works things out in his own time. You have many people praying for you.

Kim,

I am extremely excited about your recent update! I knew you would get approval, you just had to jump thru a few hoops. I was so touched by your story. Im glad everything is working out for you. I wish I would have know about both Dr. Davis' they sound like great surgeons! I know all will turn out just fine for you! I live in the SL area too, I can't wait to reach my goal maybe we can go to 1st Colony on a shopping spree, we will certainly both be needing new outfits

quote:

Originally posted by kvalera:
OMG! I cannot begin to tell you how overwhelmed and touched I am by the amazing posts on this forum as well as the OH website! The generous spirit of everyone is just...well, beyond words. I have felt so much love and concern from everyone...it's a wonderful thing!

I have just gotten good news regarding the skin on the belly, and I'm scheduled to have it taken care of in September! Once I am sure of details, I will post more information here. I'm sure there will be another battle down the road for the arms, breasts, back and thighs, but for now, one battle is done.

Please keep me in your thoughts and prayers. I'm sure my continued journey will be chronicled in the second season of Big Medicine, so all of you who have been so kind and amazing to me will be able to see how things progress.

Again, thank you SO much for your wonderful, supportive posts and emails! They have been just fantastic, and your support will help me as I continue this journey!

Hi Kim! First off I would like to say that you did an AWESOME job on your weightloss and seem to be a very positive and upbeat person!! Wooohoo!!! I just wanted to know sinice this site is not working well at all for me do you have like email or messenger we could chat because I cant post or get anywhere on here so if you could let me know I would appriciate it so we could chat!!!! Good job Kim you are awesome!

Hey, sunkissed!

I appreciate your great post! I do have an email address you can use to write to me. It is kimvalera@hotmail.com.

Take care!!

That is awesome news Kim. I just came on here tonight to see if there was any updates.

Congratulations on loosing all that weight, that's terrific.

I wanted to give you all an update on things. Yesterday I got an "official" letter from the insurance company with the approval. It wasn't a general approval this time, it was specifically for the abdominoplasty on September 4...so it's official. I'm meeting with my plastic surgeon on August 20 for the pre-op work, and I'll be having surgery on September 4. Dr. Garth will also be there, fixing a seroma I have. I'll keep you all posted on this incredible journey. Thanks again for your thoughts and prayers!!

Hi Kim,
I am so impressed by you, what a fantastic inspiration you are! Congrats on the approval for the abdomen surgery.
Mary

Congratulations on the surgery! Sept 4th is so close. It will be wonderful to see your after photos, if you care to share them with us. I hope all goes well!

Congratulations Kim!!! I am so happy to hear that you are going to be able to have some of the needed surgery done. Just keep your head up, it will ALL work out for you. God Bless!!!

Insurance coverage can be a maddening part of trying to get plastic surgery covered. We fight with it everyday!

This is by no means "cosmetic" or "vanity" surgery, but is truly reconstructive because we are trying to resore normalcy to the body after it has been deformed by the disease of obesity.

Insurance can help, but patients must have documented medical problems from the excess skin. By documented I mean doctor visits and prescriptions for skin problems.

You will also need to find a PS willing to go through the insurance process for you, and you must also be prepared for out-of-pocket expenses.

My websites have a downloadable document called "Tips for getting insurance approval" at

http://www.drlomonaco.com/patient_resources.html

plus another article in the NeWeigh newsletter you may find helpful.

Best wishes,

John LoMonaco, M.D., F.A.C.S.
Houston, Texas

www.DrLoMonaco.com
www.BodyLiftHouston.com

Hey Kim,

A friend of mine is Massachusettes sent me this article on donation of excess removed skin. They take the removed skin and and romove any unneeded fat tissue and use the skin for people that need skin graphs. Please read the article maybe you would be interested in doing a donation or anybody else getting excess skin removed in Plastice surgery.

The link is http://www.com/com/news/local/articles/2007/07/26/finding hope in donations of excess skin?mode=PF

I hope this will down load. good luck

Jeff

quote:

http://www.com/com/news/local/articles/2007/07/26/finding hope in donations of excess skin?mode=PF

I'm trying to get this to download so you can read the article

Jeff

Jeff,

I can't get the article to load. I get some weird "the web starts here" page. I'll keep trying.

Thanks for sending it.

The article:

Like an empty bag of skin. That's how Nina Esile describes the flab that protruded from her stomach to her pelvic area after four pregnancies -- including twins 13 years ago -- left her abdominal muscles severely damaged. The more Esile dieted and exercised -- she dropped 50 pounds over the past two years -- the larger her "bag of skin" became. It got to the point that the Newburyport software writer, a 44-year-old single mother of five, couldn't bear to look at herself in the mirror.
Then Dr. Beverly Shafer, a Beverly surgeon who was poised to repair Esile's abdomen and perform a tummy tuck in May, asked if she'd be willing to donate the large slab of skin about to be removed.
It never entered Esile's mind that the very flab that had caused her so much misery could be transformed into something that could help others. She eagerly signed on. Esile's "living" skin donation process was a first for Shafer, who has been a plastic surgeon for 17 years, and for Massachusetts, according to the Musculoskeletal Transplant Foundation, a New Jersey-based nonprofit organization that describes itself as the nation's largest tissue bank. Shafer is one of roughly 69 surgeons nationwide, and the only one in the state, now collaborating with the foundation on its nascent living skin program.
"I didn't want this skin," said Esile, a vivacious, now 150-pound pioneer. "Its like an old dress you hate and someone says, 'Oh, that's cool.' "
As the number of doctors nationwide seeking skin grafts for complex surgeries continues to grow, so, too, does their need for the precious tissue. The need for large grafts now exceeds the supply of skin available from deceased donors, said the transplant foundation. The shortage sent researchers on a yearlong mission to design a process for turning skin from living donors into usable grafts.
"The challenge with this skin is that even though patients have lost a lot of weight, the skin still had a lot of fat attached to it," said Martha Anderson, executive vice president of donor services at the foundation.
So scientists devised a method to remove all the fat when they removed the top layer of donated skin. They also get rid of the cells, leaving what is called a collagen matrix. Removing cells keeps a recipient's body from reacting to the graft as if it were foreign matter, which is a primary concern in organ transplants. The harvested skin is then implanted in patients whose bodies use this as a scaffolding to start rebuilding skin on their own, Anderson said.
"Recipients do not have to take antirejection drugs for living skin or deceased skin, because we have taken the cells out," Anderson said. "We don't have to do blood-type matching, either -- none of the matching you have to do with organs."
After the top layer is removed, the underlying skin, minus cells and fat, is cut and shaped into sections suitable for grafts, then packaged, frozen, and stored for distribution through the foundation.
Scientists, however, still are honing their techniques on the live-skin donations, because the surgical instruments typically used on cadavers don't work as well on pieces of live donated skin.
"We have not figured out the technology yet for how to take very thin pieces of skin from this skin," Anderson said. "Deceased persons' skin is easier to shave off because it's still attached to the body."
Skin from cadavers is ideal for use on burn victims because it is recovered in extremely thin sheets -- thinner than one ply of Kleenex, Anderson said. By creating a process to recover and use live donated skin, more skin from deceased donors will be available for burn victims, she said. The live-skin grafts can be used in a growing number of procedures, including breast reconstruction after mastectomy, abdominal wall repair for hernias, and bladder slings to control incontinence.
The foundation's first live-donor skin was recovered from a patient on Oct. 28, 2005, in Stratham, N.H. As of this month, the foundation has received a total of 326 donations, including Esile's.
While Esile did not undergo weight-loss surgery, the majority of live-skin donations come from patients who have undergone that procedure. Most have lost at least 100 pounds, and have large flaps of skin that need to be removed. Last year, an estimated 177,600 people in the United States had the surgery, according to the American Society for Metabolic and Bariatric Surgery.
The Musculoskeletal Transplant Foundation's mission to find a use for the discarded tissue also was driven by weight-loss patients, who increasingly were calling tissue banks and asking if they could donate their skin, said Scott Brubaker, chief policy officer for the Virginia-based American Association of Tissue Banks.
"We never had anyone to refer them to," he said.
For Shafer, the Beverly surgeon collaborating with the foundation, the potential uses for live skin grafts seem limitless.
"We are finding all new sorts of applications for this material," she said. "We are able to do much more fine reconstruction."
Shafer is hoping live skin grafts will be able to give a 90-year-old patient her smile back.
The woman lost part of her lips to skin cancer, and Shafer is planning to use layers of the material to rebuild her mouth.
Patients are neither paid nor charged for donating skin. The National Organ Transplant Act prohibits the buying and selling of organs or tissues of any kind.
"The wonderful thing about this is the patients who want to do this are the ones who are driving this," said Anderson, the foundation official. "We are grateful they want to make a difference in someone else's life."
For more information on the skin donation program, go to mtf.org.

Thank You much for doing that Jamie. Sometimes I just can't get the computer to do what I want it to do. Tecnician problems not Lap Top problems. Brain dead at times I am

jeff

Fascinating! I hope Dr. Garth looks at this and weighs in with his opinion!

I just met a wonderful lady who is 1 year post op on her WLS. She has been denied over and over for the plastic surgery. She just found out some wonderful news, here in california there are a few burn centers who will do WLS patients in return for the skin for grafts. I am not sure which one she is using but what a great idea to give back.

I have learned that the whole insurance process is very difficult, and you really have to learn the rules and requirements the company has in place. I was finally able to get approval for getting the tummy fixed because I was able to document that I had a medical problem that could not be fixed with medication.

What I really want to get across is that you have to know the rules that the insurance company plays by and be willing to stand up for yourself. I feel like the first "no" that they give you is designed to get people to back down and go away without getting done whatever it is they need. Lots of people either don't know about the appeal process, don't understand it or are just unwilling to go through it.

In my case, I got an initial no that I appealed. The appeal also got a big no. At that point, I got really careful about reading what they required, and set out to meet the requirements. It took a lot of persistence and a need to see my doctor once a month to document the medical intervention needed, but it paid off in the end, and they approved the abdominoplasty.

Now I need to research and get started on meeting the requirements for the rest of the procedures I'll need done....it is exhausting, but worth the fight!! (If you want more info or have questions, feel free to email me at kimvalera@hotmail.com)

Hi. As for donating the skin (or any other human body part) in exchange for ANYTHING of value, be it money, surgery fees, hospital stay, etc. it is unethical and not legal here in the U.S.

I am involved with the MTF and have used skin substitutes in the past...donating excess skin is like organ donation. It is done for altruistic reasons.

My hope is to send MTF their first donation this month!


Best wishes,

John LoMonaco, M.D., F.A.C.S.
Plastic Surgery
Houston, Texas

www.DrLoMonaco.com
www.BodyLiftHouston.com

quote:

Originally posted by drlomonaco:
Hi. As for donating the skin (or any other human body part) in exchange for ANYTHING of value, be it money, surgery fees, hospital stay, etc. it is unethical and not legal here in the U.S.

That is really good to know, and I'm glad Dr. LoMonaco cleared that up. We always hear things about hospitals that will do the surgery for free in exchange for the skin donation, but it always seemed a bit 'hinky' to me. I hope that the excess skin that will be removed from me will be able to be used to help someone in some way once it is off of me, whether it be in some form of skin replacement, research, or something else.