How Do I Ask My Insurance Company...

[jaymzee 79]

If they cover skin removal after wls? Do i just call them and ask? Or what do i say?

[Lilee84 648]

Most insurance companies do not cover skin removal as it is considered cosmetic and elective. The only circumstances where I've ever heard of an insurance company paying for plastic surgery is where a person developed rashes or infections in the folds of their excess skin.

If you want to check, I'd just call and ask if they cover plastic surgery or under conditions would they cover plastic surgery like abdominoplasty.

[O.T.R. sleever 3,386]

That's precisely what I would do, I'd ask them what their requirements are for skin removal surgery after weight loss.

Chances are they will require it to be medically necessary, I.e. chaffing, rubbing, causing rash, or limiting your mobility.

[jaymzee 79]

My doctor told me before surgery she thinks bcbs mi will cover it, i just called and they said they need diognostic codes and procedure codes.. so now i have to figure out how to get those.

[Losingitforgood! 50]

I know my insurance will cover it- but I think it's all about documenting how long you have had the lose skin- how far it hangs- rashes and such. I plan on making documentation as soon as I can to show I've had consistent problems with the excess skin- that way when I'm at my goal I'll be ready and can have it removed. (I have excess abdominal skin from having 4 kids- I already know I will have excess skin issues).

[smellbug 43]

My insurance covers a pannicculectomy which removes excess skin from the lower abdomen. They will not do the surgery until at least 18 months post-op and you need to have maintained your weight for 6 months. I have no idea on codes or anything like that.

[KS Fort Worth 86]

When insurance does cover it, it's usually called a pannectomy. This procedure covers only the removal of excess skin, whereas a Tummy Tuck addresses the muscles of the abdomen. I've heard that some people are able to pony up the difference and get a full tummy tuck.

[chitowngirl 885]

Yes, most insurance companies will cover panniculectomy. I would call and ask if you have coverage for the procedure and ask what the requirements are.. Getting approval for this procedure can be tricky. You usually have to prove that the extra skin is causing medical issues, such as rashes, ect. Good luck and let us know what they tell you.

[Wheetsin 714]

Ideally - I try to call with the CPT code the plastic surgeon would use for billing the procedure. That way there's no miscommunication. What we call a procedure, and what proceures are technically called, are usually not the same thing. You should be able to get that code from a PS's office. I think 15830 is the current code for the panniculectomy, and 15847 is the add-on for abdominoplasty. When I was near goal with my lapband I knew all this a lot better, but that was a few years ago & I got fat again since then.

Panniculectomy removes the removes excess skin and fat of the anterior abdominal wall BELOW the bellybutton (a.k.a. "apron.") Nothing is done to the skin at or above the bellybutton, or the underlying muscles. It's done to resolve issues that arise with the skin-on-skin contact in that region. MANY insurance companies cover this when it is medically necessary. Proving medical necessity can be tricky sometimes, and you'll need to ensure that your insurance company doesn't classify it as a "cosmetic" procedure. THAT's the primary make or break.

Panniculectomy, a procedure closely related to abdominoplasty, is the surgical excision of a redundant, large and/or long overhanging apron of skin and subcutaneous fat located in the lower abdominal area.

^ That's a standard for how insurance companies differentiate the two procedures.

Notice only the area below the bellybutton, above the pubic area is touched:

IMO your best bet for proving medical necessaity is to start now. If you get rashes or irritation in the area, see your doctor and have them document it. Each and every time. Then when the time comes, you should have a substantial history to prove that this is a recurring medical issue. Most of the major insurance companies that I can think of cover panniculectomy under certain diagnoses, but I can't think of any that cover abdominoplasty.

All IMO/IME.

If they cover skin removal after wls? Do i just call them and ask? Or what do i say?

[jaymzee 79]

Ideally - I try to call with the CPT code the plastic surgeon would use for billing the procedure. That way there's no miscommunication. What we call a procedure' date=' and what proceures are technically called, are usually not the same thing. You should be able to get that code from a PS's office. I think 15830 is the current code for the panniculectomy, and 15847 is the add-on for abdominoplasty. When I was near goal with my lapband I knew all this a lot better, but that was a few years ago & I got fat again since then.

Panniculectomy removes the removes excess skin and fat of the anterior abdominal wall BELOW the bellybutton (a.k.a. "apron.") Nothing is done to the skin at or above the bellybutton, or the underlying muscles. It's done to resolve issues that arise with the skin-on-skin contact in that region. MANY insurance companies cover this when it is medically necessary. Proving medical necessity can be tricky sometimes, and you'll need to ensure that your insurance company doesn't classify it as a "cosmetic" procedure. THAT's the primary make or break.

^ That's a standard for how insurance companies differentiate the two procedures.

[/quote']

They gave me 15847 for the penne and 15830 for the Tummy Tuck. I hope they didn't get it wrong.

[geno5150 168]

http://www.bcbsm.com/mprApp/mpr.do

Here is a link to the BCBS-Michigan medical policy. Looks like the do cover it for weight loss of over 100 pounds provided you meet the other criteria. Relevant text pasted below.

This procedure is considered reconstructive and not cosmetic if either Criteria A or Criteria B are met.

Criteria A: Must meet all of the following requirements:

1. 
   

The patient has had a documented massive weight loss of at least 100 pounds or whose panniculus hangs below the level of the pubis as a result of bariatric surgery or dieting; and

The panniculus is so large that it causes uncontrolled intertrigo (which is unresponsive to conservative therapy including topical drying agents, corticosteroids and appropriate antibiotics), skin ulceration, skin necrosis or chronic intractable low back pain; and

Sufficient time has elapsed (a minimum of six months) so as to ensure maximum weight loss and weight stability.

OR

Criteria B: The surgery is performed on an abnormal structure of the body, caused by a congenital defect, developmental abnormality, trauma, infection or tumor and is accompanied by a functional impairment.

Exclusions:

Surgical repair of diastasis recti, a separation between the left and right side of the rectus abdominis muscle, is not a condition for which abdominoplasty would be indicated.

___________________________________________________________________________

[jaymzee 79]

Well i called BCBS and talked to a lady after i got the codes.

The lady at the surgeons office said usually they cover Peniculectomy (sp) but not the TT.

Well the lady at BCBS says my policy wont cover the Penne, but will cover the TT.

And she said i didnt have to have any diognostic restrictions and if it was in district it would be payed 100%,

if it was out of district i think i have a 300 dollar deductable.

Also if it was an in patient procedure they had to call and get autherization first or something.

Idk, kind of seems to good to be true, so im going to call back a few times and talk to other people to see if they

say the same thing or if not what they say differently.

[NDN_RN 527]

Well i called BCBS and talked to a lady after i got the codes.

The lady at the surgeons office said usually they cover Peniculectomy (sp) but not the TT.

Well the lady at BCBS says my policy wont cover the Penne' date=' but will cover the TT.

And she said i didnt have to have any diognostic restrictions and if it was in district it would be payed 100%,

if it was out of district i think i have a 300 dollar deductable.

Also if it was an in patient procedure they had to call and get autherization first or something.

Idk, kind of seems to good to be true, so im going to call back a few times and talk to other people to see if they

say the same thing or if not what they say differently.[/quote']

That is quite a good policy. I would definitely double check. There is a little known plastic

Surgery Fellow program In NYC that has very low cost procedures. I had a full tt and lower body lift and breast lift for 3250 each. After my last massive weight loss.

[Robyn Owens-Miille 132]

Your doctor's office could submit a pre-authorization request and get an estimate of cost for you. That way you have it in writing!