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    Tuesday, July 16, 2024

    Stuck in her own skin: Insurance won't cover surgery after 300-pound weight loss

    Vickie Stevens, left, of Groton, who, after gastric bypass surgery and losing nearly 300 pounds, was denied by her insurance for surgery to remove excess skin, visits her mother, Frieda Stevens, center, who resides at the Mystic Healthcare Nursing and Rehabilitation Center in Mystic, on Thursday, Sept. 28, 2017. Also visiting Frieda is Vickie's father, George Stevens, on right. (Tim Martin/The Day)
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    A facelift, Vickie Stevens said, would be one thing. Same with breast implants and wrinkle injections, which she sees as procedures that help people to look better, not necessarily live better.

    But Stevens is just trying to live, she said, and enjoy the results of her efforts, through dieting and gastric bypass surgery, to lose nearly 300 pounds.

    “For the last two years I’ve been working my butt off, trying to get as much weight off as I could, thinking ‘Oh, no problem, I’ll be able to take care of this after two years,’” the 45-year-old said in her Groton apartment building.

    “This” is skin — approximately 30 pounds of it on her arms, back and stomach, she says — that serves as an unwelcome reminder of the weight she has lost and a roadblock to being able to enjoy it.

    Stevens has health insurance through HUSKY Health care, the Connecticut program that administers Medicaid.

    Medicaid covers weight loss surgery when a person's obesity is causing a secondary medical condition, such as hypertension or joint aches, according to David Dearborn, a spokesman for the state Department of Social Services.

    Stevens qualified for Medicaid coverage of the surgery more than two years ago, when she weighed close to 500 pounds. She ticked off the medications she was taking at the time for secondary medical conditions: drugs for high cholesterol, drugs for high blood pressure, insulin for the Type 2 diabetes she had for six years.

    After a false start — her sister's bad experience with gastric bypass spooked her out of a scheduled surgery in 2014 — Stevens went through with it, losing 50 pounds before even going into the operating room and losing an additional 200 pounds after the surgery.

    A surgeon at Middlesex Hospital completed the procedure, making her stomach smaller so Stevens now she feels full quicker. She went on a strict diet, and has started going on walks.

    Two years later, she's no longer diabetic. She can get in her car, stand up for more than a few minutes, go on walks. When her father had triple-bypass heart surgery in 2015, she temporarily moved in with her parents to help him recover, something she says she never could have done before.

    But she's been left with the skin, which hangs off her arms, back and stomach. The skin on her stomach, which stretched when she was at her biggest, now impedes her walking, causes sores and stops her from truly being able to enjoy the weight she's lost.

    And when she recently set about trying to get it removed in a procedure called a panniculectomy — similar to a tummy tuck — she was surprised to find that Medicaid wouldn’t cover it.

    A federal rule prevents Medicaid plans from covering cosmetic procedures, unless a patient can demonstrate a medical need, Dearborn said.

    Local plastic surgeons have either declined to rule that the surgery is medically necessary, or have stopped returning her calls, Stevens said.

    Dr. Jonathan Aranow, who performed Stevens’ gastric bypass surgery in 2015, estimated only 5 percent of his bariatric surgery patients get plastic surgery afterwards, and few of them are covered by Medicaid.

    But the question pops up often on online forums for people struggling with obesity. While some private insurers cover some of the cost of cosmetic surgery after weight loss, Medicaid and Medicare rarely agree to cover it.

    HUSKY Health staff members only have been able to suggest that Stevens take out loans to pay for the surgery out-of-pocket, at a cost that a Norwich plastic surgeon told her could be up to $8,000.

    Alex Mitchell, a close friend of Stevens who lives in New London, knows her pain. Mitchell had stomach surgery last year and lost 50 pounds.

    A friend and construction client helped her pay for the surgery to remove her excess skin in June, after Mitchell asked for the help.

    “It was so worth it,” she said.

    Without the help, she said she likely wouldn’t have been able to afford the out-of-pocket costs, and even if a doctor argued that it was medically necessary, they might not have won that argument with the insurance company.

    “Even with all of that documentation that you needed medication, that you have sores ... 99.9 percent of the time, they still won’t cover it,” Mitchell said.

    So Stevens is left in a gray zone in Medicaid coverage, unable to prove that the panniculectomy is medically necessary but still suffering from years of sores that won't go away and extra weight that can't be dieted or exercised off. With student loans for a psychology degree from the online University of Phoenix about to come due, and plans for a master's degree but no job, Stevens and her partner, Debra Webster, don't have $8,000 or a friend with the money to help her pay for it.

    An online fundraiser Mitchell started for her, at bit.ly/VickiFund, stalled after it generated about $75 in donations.

    Adding Stevens to Webster's private insurance plan would be prohibitively expensive at several hundred dollars more a month, and there is no guarantee that plan would pay for the panniculectomy anyway, she said. She doesn't expect to ever be able to afford surgery to remove the skin on her arms and back, which she said is annoying but not a priority.

    So, Stevens said, she feels stuck. For now, she’s looking for a job in social work, taking care of her parents, and giving rides in her truck to neighbors who ask for help getting to the store.

    Last month, she cancelled a pre-operation panniculectomy appointment she had scheduled before realizing she couldn’t afford it.

    That was "the toughest phone call I had to make,” she said.

    m.shanahan@theday.com

    Vickie Stevens, center, of Groton, who, after gastric bypass surgery and losing 300 pounds, was denied by her insurance for surgery to remove excess skin, prepares a beverage for her mother, Frieda Stevens, left, who resides at the Mystic Healthcare Nursing and Rehabilitation Center in Mystic, on Thursday, Sept. 28, 2017. Also visiting Frieda is Vickie's father, George Stevens, on right. (Tim Martin/The Day)
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