Is Panniculectomy covered by Blue Cross/Blue Shield?

I am eight years Post Op from Roux-en-Y surgery. My pre-op weight was 230 lbs. Height: 5'2". My current weight is 155 lbs. Usually fluctuate between 135-145 lbs. but dealing with grief issues and lax on the exercise. I am a 55 yr. old Retiree. Continue to have problems managing Hypertension even after surgery. Seeking a plastic surgeon in the Parkville/Towson Maryland area who accepts Blue Cross/Blue Shield but have not spoken with insurance company yet concerning the procedure. My medical plans are changing with open enrollment and part of the Wellness Plan will penalize me for the extra weight/hypertension issues if unable to control them. Just surfing and found this wonderful group! Hope someone can help me! Thank you all in advance.

No way to answer this accurately because every BCBS plan is completely different depending on the options/plan that your employer has decided to bankroll.  Some employers are incredibly generous...most are not.  

In general, medical insurance will only cover a panniculetcomy if the skin hangs down a certain amount (covering the pubis area) or if there are constant sores and skin erosion that is not improving after at least 6 months of documented treatment.  

You'll get the best answer by calling the number on the back of your insurance card and talking to the customer service people in benefits.  They can give you the specifics of your plan.  

I did call the insurance agency and had forethought to document with pictures abraded midsection during past summer which pretty much kept me sidelined. I am retired with PPO. Agency informed me that with documentation/approval from Blue Cross and choice of In Network physician, Blue Cross will cover 90% of cost. Thank you for your response.

Wonderful!  Thank goodness you had the forethought to get to the doctor and have everything documented 

Difficult to say but the plastic surgeons office you chose should definitely try and get your procedures covered. It may take time and effort on your and their part but worth it. It may take appeals also. We do this for all our bariatric patients.

Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery

1441 Avocado Avenue, Suite 307

Newport Beach, California 92660

949.640-6324/1.888.234-5080(Ca)

Website: http://www.surgery-plastic.com

Assistant Clinical Professor of SurgeryWOS-Plastic,University of California

(Irvine)

Orange County's Physician of Excellence/America's Top Physicians/Top Doctors

Plastic Surgery- 2005/2006/2007/2008/2009/2012/2013

President,American Society of Bariatric Plastic Surgeons www.ASBPS.org Non-Toxic, No Nanos Skin Care- www.ORGANODERM.com Scar Therapy-www.ScaRxtape.com

The process is just beginning. Getting physical exams with photo documentation for insurance claims. Stage 1-2 skin over pubis evident with abraded skin underneath. Thank you for your response. Will not give up!