Federal Employee BCBS & Tummy Tuck?

[abraxasbear 16]

Has anyone with the Blue Cross Blue Shield Federal Employee Program been able to get them to pay for penniculectomy or abdominoplasty, after the plan paid for your lap band surgery? If so, what did they look for in order to approve it? The current policy manual doesn't really say anything about such things, other than saying they don't cover (purely?) "cosmetic" surgery.

[jduck 0]

I am not an FEP employee, but a BCBS employee, having had Lap Band surgery and getting ready for the last leg of my weight loss and a full Abdominoplasty. My plan will cover this procedure because it is a medically necessary surgical procedure for skin removal. Good luck!

[TucsonAnnie 2]

Wondering the same thing here. I know FEPBlue is good when "medical necessity" is proven on most things, but I worry I will be needing the same surgery/surgeries next year. I hope not!

I saw in another thread somewhere that someone's apron caused infection. I am sure irritation and infection would be followed by your general doctor, so it would be charted. I imagine that it would be sufficient to send to the UR./approval nurses at FEPBlue to see if a pre-approval could be written. Then again, I have dealt with them on the lapband surgery, and know how some things are approved, but then they don't guarantee payment. It's scary. The manual is almost cryptic. We pay an arm and a leg for the coverage, I think they should take excess skin as payment too!

Has anyone with the Blue Cross Blue Shield Federal Employee Program been able to get them to pay for penniculectomy or abdominoplasty, after the plan paid for your lap band surgery? If so, what did they look for in order to approve it? The current policy manual doesn't really say anything about such things, other than saying they don't cover (purely?) "cosmetic" surgery.

[Momto3redheads 18]

I have BCBS Basic - I have had a small rash under that flap of skin ever since a few months after surgery - so I just make sure to have my general doc AND my OBGYN document in my chart every time they see me about it.....since I haven't been going back to my surgeon as often. The best bet from what folks have told me is to make sure to have documentation that it is necessary due to it causing a problem.....I am not going to pursue surgery until I get my rear in gear and lose a bit more....but it is definately in my future!

Kim

[nomorejellybelly 77]

I'm interested in answers to this. I have BCBS FEP.

[MelindaH 3]

Has anyone with the Blue Cross Blue Shield Federal Employee Program been able to get them to pay for penniculectomy or abdominoplasty, after the plan paid for your lap band surgery? If so, what did they look for in order to approve it? The current policy manual doesn't really say anything about such things, other than saying they don't cover (purely?) "cosmetic" surgery.

I am covered under BCBS FEP Standard. I am planning on lap band surgery in late Sept, early Oct. and am in the process of jumping through their hoops. I have several co-morbities so I don't think it will be a big problem to be pre-approved. I also have Ehlers Danlos Syndrome which destroys the elasticity of the skin and I already have saggy skin most every where you can invision. I am sure that I will need at least an abdominoplasty after I lose weight. I have read the plan backward and forward and upside down and have talked to their cust svc several times over the years. I have been told that it is approved when medically necesary only. They suggested that I see my doctor anytime I have a skin infection so that it will be well documented. Personally, I do not look forward to any plastic surgery as I have heard it is really painful and most of it is done outpatient so they really can't use or give adequate pain control. I chose the lap band because the weight loss is slower and hopefully that might not make the connective tissue issue that much worse than it already is. Unless the plan were to approve any plastic surgery, it won't be an option for me. All the best to you. Hope this helps.

[ASUgrad 61]

Bringing back this old thread - Can anyone with BCBS federal tell me if they tried to have any plastics covered? What was the process like? Did you have to show proof for a number of months?

Any info is helpful! Thanks!

[Rovobay 920]

I am also getting near goal and curious about coverage of this type of surgery!!!