Skin Removal Approvals

[livvsmum 2,369]

Just curious....has anyone had any success having skin removal surgery approved by insurance for stomach or arms? I have highmark bc/bs and have been working with my PCP to document skin problems related to the excess skin. So far I have 3 visits worth of documentation. I'm wondering when I should submit it to insurance and if anyone has had any success in doing this?

[jes76 16]

Just curious....has anyone had any success having skin removal surgery approved by insurance for stomach or arms? I have highmark bc/bs and have been working with my PCP to document skin problems related to the excess skin. So far I have 3 visits worth of documentation. I'm wondering when I should submit it to insurance and if anyone has had any success in doing this?

[jes76 16]

That is an excellent question.

I have the same insurance and my surgery is scheduled for next week Thursday. Oct. 23rd.

[jes76 16]

Hey, @@livvsmum I am curious....did you have to pay your deductible upfront? It hasn't been mentioned by my insurance or surgeon's office and I would like to know. I have had surgery before with other insurance and didn't have to pay my deductible upfront, but it wasn't surgery that needed approval first. Except for my C-section.

[livvsmum 2,369]

That is an excellent question.

I have the same insurance and my surgery is scheduled for next week Thursday. Oct. 23rd.

Did you get pre-approval first or are you still trying to get it covered? I talked to the insurance company yesterday and they said I would need to get pre-authorization and their requirements are 18 months post-op from sleeve surgery, at least 3 months documented "other treatment failures" with the PCP, and photo documentation from the surgeon. If those requirements are met they will likely approve it.

[livvsmum 2,369]

Hey, @@livvsmum I am curious....did you have to pay your deductible upfront? It hasn't been mentioned by my insurance or surgeon's office and I would like to know. I have had surgery before with other insurance and didn't have to pay my deductible upfront, but it wasn't surgery that needed approval first. Except for my C-section.

I haven't sent it in for approval yet because Im' only 13 months post op and have to be 18 for insurance to cover it. But, I did use the same insurance for my sleeve surgery and the only thing I had to pay up front was the co-insurance, which for me was 10% or $1,000. It was due to the hospital by the morning of surgery.The hospital had me pay the $1,000 then after everything was said and done they reimbursed me $150 of that because the 10% ended up being less. Hope that helps!

Edited October 16, 2014 by livvsmum

[Jersrose43 837]

You pay your deductible to either surgeon or hospital depending on who gets it charged to them.

They have to send the bill in to get paid and then they send you a bill.

I would not pay up front at all

[sweeteyes504 66]

Are there any federal insurance companies that cover this? I'm newly sleeved 22DEC14. But I know my "federal Nalc cigna" won't cover it.... just thinking of who I can switch to when it is time?

[Jersrose43 837]

Are there any federal insurance companies that cover this? I'm newly sleeved 22DEC14. But I know my "federal Nalc cigna" won't cover it.... just thinking of who I can switch to when it is time?

Here is the medical policy for cigna

They cover the paniculectomy 18 months post sleeve at a stable weight but read the requirements carefully.

I am 6 months out and my doctors are all hearing loud and clear about itchiness and such.

You read me? Hint hint

https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0027_coveragepositioncriteria_abdominoplasty_and_panniculectomy.pdf

[sweeteyes504 66]

@@Jersrose43 thanks but i have NALC Cigna its a federal option an it says no cosmetic surgery not sure what u have applys for me... i do hear alot of ppl sayin document skin issues