Personal Choice Blue Cross/Sheild Pays for Reconstructive After WLS ...WHAT??????

Spedteacher59
on 6/30/10 10:34 am - Levittown, PA
So, I got a call from Barix today asking how I am doing after my 1 year WLS surgery...blah blah. Then she asks me have I thought about reconstructive surgery. I said, "yes, but my insurance won't cover it right?" She says, "Oh you have Personal Choice...they are very good about covering the surgery. They usually cover a tummy tuck and a breast lift." I say, "Oh my gosh really!" She says, "Well it depends on how much hanging skin you have...but yeah. Ask Dr. Boe to check you and discuss it when you go in for your one year check up." Well my one year check up is on July 15th and I have plenty of hanging skin! Can this really be possible? I really didn't think insurance would cover what I believe they would think of as cosmetic surgery. Has anyone ever heard of this w/o having significant skin abcess etc. issues?? Also, if you had it done how bad is the pain factor?

Thanks a bunch,
Kathy
dhaworth
on 6/30/10 10:55 am
I have Blue Cross and my TT was 100% covered, a breast lift was not covered, but a reduction would have been.  I didn't have much hanging skin at all, I had lost 100 lbs and that was the only criteria I had to meet.

Good luck to you!!!
Spedteacher59
on 7/2/10 6:47 am - Levittown, PA
Thanks....I could live with just my tummy being covered. It seems from the responses I have gotten they really pick and chose who and what they will cover with no real rhyme or reason.
Kathy
Jupiter6
on 6/30/10 11:23 am - Near Media, Pa- South of Philly, NJ
I have the same plan as you do (BC BS PersChoice) and had excessive piles of skin after a 220 pound loss, with huge weeping rashes, festering sores and three years of treatment and photos documenting all of it in graphic detail, and still NONE of it was covered. I appealed twice, and nada. I had three peer to peer consults and letters from three doctors explaining the medical necessity.

None. Zero. Zilch. Nada.

Pain factor? You can't even imagine. Seriously.

 "Oh sweet and sour Jesus, that is GOOD!" - Stephen Colbert  Lap RNY 7/07-- Lap Gallbladder 5/08--  
     Emergency Bowel Repair
6/08 -Dr. Meilahn, Temple U.  
 Upper and Lower Bleph/Lower Face Lift 
12/08 
     Fraxel Repair 2/09-- Lower Bleph Re-Do 5/09  -Dr. Pontell, Media PA  Mastopexy/Massive 
     Brachioplasty/ Extended Abdominoplasty 
(plus Mons Lift and Upper Leg lift) / Hernia Repair
      6/24/09 ---Butt Lift and Lateral Thighplasty Scheduled 7/6/10
 - Dr. Ivor Kaplan VA Beach
      
Total Cost: $33,500   Start wt: 368   RNY wt: 300  Goal wt: 150   Current wt: 148.2  BMI: 24.7

Spedteacher59
on 7/2/10 6:45 am - Levittown, PA
Sorry to hear they didn't cover you............unbelievable with all the problems you had. I hope I have better luck because I can't afford to do anything at all if it's not covered.
Kathy
Lisa R.
on 6/30/10 11:53 am - Cleveland, OH
For them make the broad statement "they're pretty good about covering..." is very misleading.  An inusrance company writes policies for companies based on what the company (your employer) wants to cover.  The more that's included, the higher the premiums.  So it really depends on how the policy is written for your company.

Contact your HR rep for a copy of your policy if you don't have one.

As for pain, that depends on the pain tolerance of the individual.  For me the LBL wasn't as difficult as the thighs.  For others, it's the opposite.
RNY:  10/11/2001 PS:  May 28, 2010: Circumferential body lift with gluteal augmentation and brachioplasty & thoracoplasty June 25, 2010: Bilateral breast augmentation with mastopexy and medial thigh lift

    
Terrence_CA
on 7/1/10 8:21 pm
I have Blue Cross PPO insurance. My dooctor submitted for a circumferencial body lift, medial thigh lift, breast lift, torso lift, and an arm lift. The only thing they decided to cover was my arms of all things. I am going to appeal the body lift and thigh lift and hope they cover at least one. Hopefully it will be the body lift as that is the most expensive lol.
Gastric Bypass 8/14/08
SW: 513 lbs
CW: 250 lbs




Spedteacher59
on 7/2/10 6:42 am - Levittown, PA
How odd is that???? Just the arm lift??? You would think that one would be the last they would cover. Good luck on your appeal.
Kathy