Question:
Has anyone had their plastic surgery covered by BCBS?
I visited a plastic surgeon last week and was wondering if Blue Cross Blue Shield every approved a tummy tuck, breast reduction or having skin removed from your arms? — Linda V. (posted on May 16, 2004)
May 16, 2004
A lot of insurance plans will pay for a tummy tuck if you can prove that it
is medically necessary due to rashes, pain etc. It is very difficult to get
coverage for the arms. You have to have proof to get breast reduction done.
Most policies require that a certain amount of weight be removed from each
breast to get payment. Document everything.Use photos if possible. Document
arm, shoulder and back pain, rashes, problems getting clothes that fit
properly and any depression that you experience related to altered body
image.Good luck.
— dianne E.
May 16, 2004
My BCBS United of WI policy did cover my full extended abdominoplasty and
actually in 2 stages. The 2nd stage will be June 7th. Due to anatomy they
could not perform it as normal and pull all the skin down and cut off so
the portion above my waist has to be directly excised in a separate
procedure. Means I end up with more scars but the skin will be fully
gone.
<p>My approval was built in my years of low back problems. I have
degenerative disc disease in 3 discs and removing the skin was a logical
way to help manage that condition. It took an orthopedic evaluation and
recommendation to get the approval, which BCBS paid for, but I got it.
They initially denied me with a letter from the WLS, PS and neurosurgeon
stating it appeared to be cosmetic. But they left the door open by saying
they would review it again when I was at the weight I want to attain and
with new pics and the ortho stuff. They basically led me down the path to
what was needed for approval, which is really strange with BCBS. Once I
got the ortho stuff and delivered new pics and a letter I wrote to them, I
had approval within 48 hours. I wasn't anywhere close to goal but I
explained my reasons for asking for approval at that point etc. and it must
have satisfied them.
<p>As I'm sure you are aware, not all BCBS policies are created
equal. I was able to prove a medical necessity so they approved it. If
the back would not have worked then I would have been out of luck as I have
never had any rash issues. I actually had a lower body lift of which I had
to pay for the lateral thigh portion. BCBS did not see a need, other than
cosmetic, for having it done, which is mainly accurate. Although my
reasoning was because if I didn't I would not have had thighs that began to
fit into pants and skirts that would fit my new gut. I was going to fight
it but basically ran out of time. I was wiped after surgery and I only had
about 18 days left then to file an appeal and I was just too darn tired. I
figure insurance fully covered my WLS and this portion of the PS, so I
would let it go. I am scheduled to have my legs done in November but I
don't even plan to submit to insurance for approval. I just don't know
what I would do to justify it as medically necessary. I am doing it
strictly for visual reasons, as my legs are so out of proportion to my
upper body and they are a bowl full of jelly. It just looks very strange.
It almost felt better when I still had the gut skin because then at least
it all went together. Arms is a 99.99% chance of zero insurance coverage.
If you have severe infections maybe, but even then good luck. I won't even
waste my time applying for that one in my case. Nothing but cosmetic
associated with the need.
— zoedogcbr
May 16, 2004
My BC/BS plan only covered my abdominoplasty. I self paid for my arms and
thighs. I haven't submitted for a breast lift but I'm not counting on them
paying for it either.
— Patty H.
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