Panniculectomy questions

Hello, I'm new to this site and I'm hoping to get some help.

I've lost 120 pounds and have a big overhang of excess skin. I'm praying when the time comes and I am ready, that my insurance will cover a panniculectomy for me.

I have 3 questions 

1.) If your insurance covered your panniculectomy, was the process difficult? Did you have to have a lot of documentation? What criteria did you have to meet?

2.) If insurance covers a panniculectomy, can you pay the extra amount out of pocket for a full tummy tuck? Do surgeons do this?

Thank for your time and help! I will keep in touch :)

Hi

My insurance is covering my panni.  My NP documented any rashes I had (even by phone), and also had prescribed me an anti-fungal cream.  I think this kind of history is very helpful for gaining approval.

When I went for my plastics consult, they took pictures to submit to insurance, along with the info they obtained from my NP.  It was approved on the first submission.

I am paying an additional amount for a full tummy tuck.  The insurance part (panni) is covering the one night stay in the hospital.  I am also having my arms done - this is not covered by insurance.

So yes, you can combine a covered procedure with out of pocket.  Make sure you understand what is covered by each so there is no "double dipping" by the surgeon.  For example, if both procedures called for a night in the hospital, only pay for it once.  Your surgeon's office should be very transparent on what is included with each procedure and work with you accordingly.

Do you mind me asking how much of a discount you received on your tummy tuck since your insurance covered your panni?

For example, tummy tucks in my area go for about 8k. Do you think I would save about half of that? 

Hi - sorry I just saw this :-)

I only saved about $1k on the tummy tuck itself. But $6k is being paid for on the panni.

Breaking out the abdomiplasty and panni separately, I think they were $5k and $6k respectively.  I need to stay a night in the hospital which is being included in the panni...The $1k is the cost of the one night stay...which is being paid for by the insurance because it's deemed necessary for the panni.

It's hard to know how much you'd save until they break it out - but it seemed like a pretty even split between the two procedures, and they certainly worked to get insurance to cover as much as they could.

For me I know I could have saved $$ not getting the tummy tuck, but I have so much loose skin from the upper abdomen downwards, it would be crazy to go through this and not get it all taken care of.

7 more days....eek!!

Hi, so glad to hear your insurance paid for part of your needs.  I have a grade 3 pannus that began when I had Cushing's disease i*****  I am well from Cushing's now since 2003, no diet or exercise can get rid of my hanging pannus or hanging triceps.  The plastic surgeon in Tyler, Tx. said I needed a tummy tuck, my BCBS said they will pay after documentations are sent in with proper code.  He will not even try, nor the one before him.  I only have some subcutaneous fat above the waist line that could be liposuctioned and then pannus removed.  

Still searching for the surgeon who will use my great insurance.  Any advice is appreciated.  I am documenting rashes, but have back pain.  The Cushing's disease started the entire thing, so disease is a plus on this, hard to do a day's work as Cushing's also partially destroyed inner and outer muscles.

Hello Michelle_Marie3,

I had RNY in 2007 and I have Federal Blue Cross/Shield (I'm a federal employee) and have been approved for the complete abdominoplasty (Tummy Tuck) with muscle and hernia repair!

Over the past few years I've been treated by my Primary Care Physician for rashes under my apron and prescribed an anti-fungal powder and creams. 

First thing I did was sign release of information and had my PCP fax my health records pertaining to those visits to my Plastic Surgeon.

 My PS requested pre-certification (pre-approval) for abdominoplasty, faxed documentation of rashes and treatment from my PCP and sent copies of pictures he took showing my abdomen.  

I was approved in 1 Day!! He faxed/sent info on a Thursday, I called(1-800 number on back of insurance card) on the following Monday just to see if they had received pre-certification and was told it was not only received but approved on the previous Friday!!!

My surgery is a few months away in April 2016. I'm so excited!!! Me doing the happy dance!!

I know this is post is old and I'm way ahead of myself considering I'm only 3.5 weeks post op, but I also have Fed BCBS. This is encouraging!

Hello Sarafer,

The post isn't so old....November 2015. Today I'm one week away from my Tummy Tuck.  My surgery date was moved up to 2/16/16. I'm so excited. Congrats on your surgery!!!Hope your feeling and healing well. Please send healing thoughts for me come next week. Getting a little nervous.

Insurance usually covers a panniculectomy and I do offer an "upcharge" to do a full,extended tummy tuck.