BCBS Il and plastics

[genagee 0]

Hi all, I had the sleeve done 2 years ago this month. I've lost 100lbs and I'm interested in have this ugly hanging skin removed from my tummy. I have Blue cross blue shield of Illinois, does anyone know if they will pay for at least a panniculectomy? Thanks in advance. ..

[JamieLogical 8,708]

I'm in NY and my BCBC policy explicitly states that it does NOT cover skin removal surgery for loose skin caused by WLS. Hopefully your policy is a little better! You should call and talk to a representative to find out for sure.

[Sue Magoo 71]

Some insurance will cover if it's medically necessary - repeated rashes, etc. Most won't cover for just cosmetic reasons. I had mine covered by BCBS several years ago after having repeated rashes, embarrassing pics sent by doctor, etc.

It really depends on your specific insurance plan as they vary tremendously.

Good luck!

[Laurac727 92]

There you go Sue is right, i also have BCBS of IL and yes medically necessary they will consider with proof in the pudding, just like our WLS. They will have to show proof of need and apply for approval first. So work with PCP and probable surgeon on getting ducks in line first..........

[TheRealMeIsHere! 863]

At the time, I had Blue Cross, in New York State, they fully covered a panni AND TT. They required at least one year at a normal BMI.

I have severe ankylosing spondylosis in my entire spine, so I started with pain management. I went on my insurance website, and searched 'criteria for panniculectomy'. Took that to pain management doctor who wrote a letter of medical necessity that echoed all the criteria needed. I also wrote a letter that spoke about the co-morbidities that were resolved with weight loss (HBP, SEVERE apnea) and how exercise is crucial in keeping weight off. Also how the extra skin, was limiting my range of motion and exercise options. This along with the plastic surgeon's pictures and prior approval request went to my insurance company. And the stars and planets aligned, lol, it ended up on the right person's desk and not only was panni approved, but also abdominoplasty!! I was SHOCKED and showed the approval letter to several people who were just as surprised, including the plastic surgeon.

All insurance is different, though. The surgeon said that one insurance company required that the patient have rashes and infections so severe that they needed to be hospitalized and on IV antibiotics!