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The Journal Gazette

Sunday, February 11, 2018 1:00 am

Excessive skin creates issues

Insurers won't pay after surgery

SHARI RUDAVSKY | Indianapolis Star

INDIANAPOLIS – Bariatric surgery held out the promise of a new life for Stanley Hollar, who at his peak weight tipped the scales at nearly 700. Two years after his surgery, the Rushville man has lost nearly 500 pounds. But his days of obesity still haunt and hobble him – literally.

Hollar, who lost his leg below the knee years ago, can no longer use the prosthetic that fit his former, much larger self. He also carries around pounds of excess skin that further impede his motion. For while his fat has melted away over the past two years, it left behind the skin that once encased it.

“I have bat wings on each arm that drop down about four inches. ... I can pull back my love handles and pull the skin up four or five inches,” said Hollar, 42, who currently carries about 190 pounds on his 5-foot-10 frame.

However, most insurance carriers, including Medicare which Hollar has, decline post-bariatric skin removal surgery, deeming it cosmetic. So Hollar is trying to raise $25,000 to cover the costs of surgery and a new prosthetic that will fit his new leg. His old one is the circumference of his new waist.

Most patients over the age of 30 who have bariatric surgery can expect some loose skin, Dr. Samer Mattar, president of the American Society for Metabolic and Bariatric Surgery. Past that age, skin tends to lose its elasticity, so if someone loses a substantial amount of weight, the skin will not just recoil. The resulting skin can lead to health problems such as rashes or infections.

More than half of the patients who undergo bariatric surgery could benefit from skin reduction surgery, said Dr. Scott Kahan, a spokesperson for the Obesity Society. About a third could have health reasons for having such a procedure.

As a bariatric surgeon, Mattar said he sees little difference between this surgery and breast reconstruction for women who undergo mastectomies.

“Why would you exclude them from having this very beneficial coverage?” said Mattar, also director of Swedish Weight Loss Services in Seattle. “It's a form of discrimination and bias against poor people who have suffered all their life. They are finally making very courageous, momentous decisions and this is part of the continuum of care.”

Often Mattar will try to help his patients by documenting the health toll the excess skin takes, listing the various complications that it has caused. Sometimes he'll take pictures of the patient and send that along to the insurer. He'll refer his patients to a dermatologist, suggesting that instead of treating the skin irritation with an over-the-counter cream, they incur the cost of a doctor's visit and a prescription medicine, more proof that the problem is not a solely cosmetic one.

In some cases, insurers do cover treating an underlying medical condition that arises from excess skin, said Cathryn Donaldson, communications director for AHIP, America's Health Insurance Plans, a trade association for health insurers. If an insurer turns down the first request for coverage, saying it's not medically necessary, a patient can always appeal.

“Health insurance providers work to ensure patients have access to effective, quality, evidence-based care they need,” Donaldson said in an email. “Overall, specific coverage and benefits for any procedure, including post-bariatric surgery, will vary based on the individual, the health plan they select, network, and local market.”