Insurance And Reconstrutive Surgery

[jennifer1 180]

I was self pay for my band..I haven't looked at my insurance policy yet..but has anyone had their insurance company cover any surgeries such aa TT's or breast lifts?

[Cazzy 725]

Having read this forum regarding this question, it would seem common that there would have to be a medical need for any excess skin to be removed. U need to check if your insurance cover this and then u need to ask what the criteria is to get the costs met. Breast lifts would normally not be covered as this would be seen as cosmetic, but theres always exceptions to the rule and hopefully some other people who have had this done can help guide u. First port of call tho is getting the info from your own insurance company tho so .. good luck !

[jennifer1 180]

Thanks...I was just being lazy..I will contact my insurance company..lol

[change4life10 1]

Let us know what you find out.

[Electrawoman 5]

Most insurance will cover the panniculectomy (removal of the pannus) if it hangs below the pubis. This is helpful and may be a good enough treatment for most people.

To pay for the panniculectomy, insurance may require that you document a history of rashes (which can be caused from poor hygeine and other factors) and usually, they will want pictures of your pannus. (Just visit your doctor for your next rash and get them to put pics in your chart. Then call to document future rashes by asking for RX refills for each one. Make sure to fill the prescriptions, otherwise your insurance could fight you and say "It must not be bad enough if you don't even treat it properly").

Insurance will rarely pay for the TT unless other factors can be documented for reconstruction such as rashes, lower back pain, and hernia. It is important to start the documentation process with your doctor now. Just mention the issues your pannus causes every time you talk to you doctor(s) (not just your WL Surgeon) to create that history.

I have BCBS TX and found that they will pay for TT if I have an umbilical hernia (I do and you may, too. They don't hurt and sometimes you only know you have one if you notice a mass or bump in your abdomen upon sitting up from a lying position. Do a slow sit up and check for weird bumps--google search umbilical hernia for more info on what to look for).

http://www.livestrong.com/article/481156-stomach-protrusions-with-sit-ups/

Insurance will pay for TT to correct this because, while they don't immediately cause problems, a hernia can become strangulated and serious).

It was not easy to find this information. Before you call your insurance, search the internet for Medical Policies for your insurance. Here is an example of the portal to get provider specific medical policies for BCBSTX:

http://medicalpolicy.hcsc.net/medicalpolicy/disclaimer.do?corpEntCd=IL1#hlink

These policies are written for the doctors and provide detailed lists of what they will cover and why. If you call your insurance and ask for this, they are probably going to give you a hard time. They will try to limit your knowledge of specific policies. Remember, they do not want to pay for your care and if you don't know the rules, they can deny you easier. Most people get frustrated and just give up after one denial and they count on that. No insurance wants to pay for anything they don't have to. Also, remember that every time you call your insurance company, they document your call and will build their own history of what you are asking about.

You weight loss surgeon or plastic surgeon is a great source of information. However, I would recommend that you find the medical polocy guidelines FIRST before seeing the plastic surgeon or PAY CASH for your first surgeon's visit and keep it off insurance until you find out what you need to document/prove. Know what you need to prove before you try to prove it. Your doctor will probably have copies or access to medical policies and specific guidelines for your insurance because they have been through this before. They are often very willing to help you decipher the secret code of insurance nonsense because they have to deal with these people on a daily basis and get just as frustrated as we do.

[Electrawoman 5]

Here is a direct link to BCBSTX reconstructive surgery guidelines with DX codes

http://medicalpolicy.hcsc.net/medicalpolicy/home?ctype=POLICY&cat=Surgery&path=/templatedata/medpolicies/POLICY/data/SURGERY/SUR716.001_2012-01-15#hlink

[DELETE THIS ACCOUNT! 12,703]

I am on Medicare, and I know they will pay for a panniculectomy after 100 pounds or more weight loss. My breasts are very large still despite the weight loss, and they will cover a breast reduction with lift. They won't cover the cost of a lift alone, though. Only when done with a reduction.

I am hoping to have both surgeries next summer.

[barbie64 5]

My insurance paid for a panni. Today I saw the plastic surgeon and they won't pay for brachio. I kind of knew this already. The others are right, the ps will find out what is covered easily. Documentation of any rashes is very important.

[DELETE THIS ACCOUNT! 12,703]

My insurance paid for a panni. Today I saw the plastic surgeon and they won't pay for brachio. I kind of knew this already. The others are right, the ps will find out what is covered easily. Documentation of any rashes is very important.

I was told by my surgeon I should start going to my GP regularly to document rashes, so by the time I'm ready for surgery we'll already have many months and visits on file. He knows I have a lot of skin on my thighs and upper arms as well as my stomach and I think he's hoping maybe we can get them to cover that too. (though honestly, I'm doubtful)

[vonhelzing 3]

i have blue cross and they paid for a breast lift but it had to include a reduction which was fine with me.

[barbie64 5]

I was told that my insurance excluded brachio. Would not be covered for any reason. I'm hopeful of a breast lift, but don't think I'm blessed with enough bust to require a reduction which may be a requirement.

[jenn9585 39]

I am on Medicare, and I know they will pay for a panniculectomy after 100 pounds or more weight loss. My breasts are very large still despite the weight loss, and they will cover a breast reduction with lift. They won't cover the cost of a lift alone, though. Only when done with a reduction.

I am hoping to have both surgeries next summer.

this is good 2 know im on medicare and have a appt sceduled at the end of this month ...ive only lost 80 but still would like to loose at least another 30-50 so by the time i hit my goal weight maybe they would cover me for the surgery now ive just recently started getting rashes so nothing is documented should i start going to my doctor to get this documented?

[DELETE THIS ACCOUNT! 12,703]

this is good 2 know im on medicare and have a appt sceduled at the end of this month ...ive only lost 80 but still would like to loose at least another 30-50 so by the time i hit my goal weight maybe they would cover me for the surgery now ive just recently started getting rashes so nothing is documented should i start going to my doctor to get this documented?

Yes definitely, get it documented. It will help.

[Virtiouswoman 14]

I have Aetna PPO Plus and my friend has had the LapBand Procedure which left her with sagging breast and rashes under them from the excess skin. She had a TT also do to the excess skin and rashes! Yes keep in your Medical History record with both Dr for when the time comes! Go to your PCP and your Surgeon who did your procedure and it can be cover by your insurance as a Medical necessary Surgery that's needs to be done ! You were already pre classified as a Morbid Obese or Obese patient for the LapBand Procedure.. Mean while walk and drink plenty of Water and your skin may adjust on its on to you new body weight without reconstruction surgery. That's why it's so important to get the daily water and Fluid intake. Good luck with your new bodies! I'm just 8 days post op and have my follow up tomorrow at 2pm.