Question:
I have a choice of health plans and I want to pick one likely to approve plastic surg

I am just changing jobs and have 3 new health plans to choose from. I live in PA and want one that will cover plastic surgery. They are Aetna, Independence blue Cross Personal Choice and Keystone Health East. Has anyone gotten insurance approval for plastic surgery with any of these plans. Your feedback would be most appreciated! I paid for my RNY because my insurer didn't cover it. I can afford to pay out of pocket again! Thanks!    — Brenda G. (posted on August 22, 2003)

August 22, 2003
It's not about the insurance companies, it's how the person qualifies under the guideline. Each insurnace company has to do a medical reivew to determine "medical necessity" vs Cosmetic. If your PS writes a good letter of medical necessity, you have other health providers give letters of history (back pain, rashes etc) and the photos are consistant, then they will have to approved based on the medical necessity of the procedure. Good Luck!
   — ZZ S.

August 22, 2003
I would ask the insurance person at the plastic surgeons office recommended by your surgeon or pcp. They may be able to tell you which companies are most receptive.
   — Tawnda C.

August 25, 2003
My advice is, be sure to read the plan and understand what it does and, more importantly, does NOT cover. I knew I was planning to have WLS when it was open enrollment time for my insurance. I was going to go with the much more costly PPO plan because I assumed it would have better coverage. WRONG!! The PPO plan had a specific exclusion for all weight loss expenses, including surgical, even if your doctor considered it medically necessary. The HMO plan, on the other hand (which cost about $1200.00 LESS), did not exclude WLS, it just required proof of medical necessity as considered by NIH guidelines. Needless to say, I went with the HMO, and the ease with which I got my approval still amazes me! Of course, it didn't hurt my chances that I had a BMI in the low 60s. Anyway, the bottom line is, READ YOUR POLICY!! If it has an exclusion, it will take an act of God to get your surgery approved. Good luck! Hope it works out for you.
   — Maggie T.

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