Plastic Surgery Did your Insurance pay for it

puffierus
on 1/20/14 2:25 am - PA

 

Hello All

 

I have a hernia and my surgeon suggested that I wait 18 months to have it repaired , because at that point I would most likely need a tummy tuck. He implied that the insurance would pay for the tummy tuck, if it was part of the hernia repair.    My friend who had her surgery done over a year ago with a different Doctor also was told that the tummy tuck could be covered by insurance if she had a history of rashes and irritations. Well when her year was up the plastic surgeon told her the insurance would not cover it after all so she is waiting. We both have Blue Cross & Blue Shield different versions. I was  wondering if anyone has had a tummy tuck that was paid for by insrurance.

 

Thanks for your help Deb

 HW 268   SW219   CW 181.2 surgery date 10/31/2013

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MeAreToo
on 1/20/14 3:07 am - TX
VSG on 12/27/13

It's not just the insurance company but mainly the policies. Get a copy of what's covered and what's exempted. Especially the "medically necessary portion". It could be the surgeon doesn't except that insurance. It maybe something she needs to appeal. Make sure any problems with the skin is documented align with medications and creams. The skin is the bodies biggest defense against infection. I know my cigna ppo deductible policy will cover it as long as it doesn't get changed. Good luck, Happy loosing!

MeR2 

                                
Sparklekitty, Science-Loving Derby Hag
on 1/20/14 4:59 am
RNY on 08/05/19

I agree-- get a copy of your benefit listing to see what it says. You can also call the customer service number on the back of your insurance card and ask them about it, they can give you more information (generally speaking) about what is and isn't covered.

Sparklekitty / Julie / Nerdy Little Secret (#42)
Roller derby - cycling - triathlon
VSG 2013, RNY conversion 2019 due to GERD. Trendweight here!

KevinBacon
on 1/20/14 5:03 am
VSG on 03/10/14

My policy (Tricare through military)  has recently piggybacked TT as part of the WLS "package".  You can get it as soon as you maintain your weightloss for 1 year. 

HW: 318 Date of Surgery: 3/10/14 SW: 270  CW: 154

  

happyteacher
on 1/20/14 5:17 am

Hello,

I also have BCBS.  They paid, and I just had it done on December 9th.  I had the following requirements to meet- lost at least 100 pounds due to wls, pannis hangs done below the pubic bone, and rash issues.  I had a doctor document a rash and a prescription was given.  Now, it did not cover the full tummy tuck- it only covered the removal of the pannis.  I was charged $2,000 for the vertical cut that included the muscle tightening.  While he was in there, he repaired a hernia near the belly button area, so hopefully that will offset the hospital and anesthesiologist portion from that vertical cut.  I do not have the EOB's yet, so not sure.  Honestly, whatever it turns out to be- totally worth it.  The office staff indicated pre op that patients report back not getting charged for anything other than the $2,000 so here is hoping!

If it is a hernia situation where it helps is that the hernia will cover the cost of the repair, hospital stay etc.  You would only pay a pro rated part for the time the doc used to do the TT part... a huge savings. 

Surgeon: Chengelis  Surgery on 12/19/2011  A little less carb eating compared to my weight loss phase loose sleever here!

1Mo: -21  2Mo: -16  3Mo: -12  4MO - 13  5MO: -11 6MO: -10 7MO: -10.3 8MO: -6  Goal in 8 months 4 days!!   6' 2''  EWL 103%  Starting size 28 or 4x (tight) now size 12 or large, shoe size 12 w to 10.5   150+ pounds lost  

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mickeymantle
on 1/20/14 7:48 am - Eugene/Springfield, OR
VSG on 07/22/13

sometimes they will not cover the plastic surgery but if done at the same time as other surgery (hernia) they will cover the hospitalization and Anastasia

and if the same surgeon does both you may get a deal on the plastics , the pre op testing should also be covered

    

   175 lb  lost,412 hw 336sw,241 cw surgery July 22 2013,surgeon Dr Colin MacColl,

 

  

                                                                                                             

 

 

 

jessies824
on 1/20/14 4:33 pm
VSG on 02/04/14

what would you search for under the insurance to see if its part of your policy? im having my surgery the 4th and would love to know if this is an option down the road

jujubslim
on 1/20/14 11:54 pm
VSG on 03/17/14

By any chance do you have independence Blue Cross? They just revised their policy:

 

Notification



Abdominoplasty and/or Panniculectomy
Notification Issue Date: 01/03/2014

This version of the policy will become effective 2/3/2014.

  • The 6-month requirement for medical treatment of intertrigo has been decreased to a 3-month requirement.
  • Limited, exceptional clinical cir****tances have been added to this medical policy as medically necessary for a panniculectomy performed on the same day of service as another medically necessary procedure:
  • There are limited, exceptional clinical cir****tances where a panniculectomy performed on the same day in conjunction with another medically necessary procedure is also medically necessary and, therefore, covered when the respective criteria are met:
  • At the time of a hysterectomy for a oncological condition when the woman has a concurrent, large overhanging abdominal pannus
  • In an individual with multiple, recurrent ventral hernias with multiple surgical scars when mesh has been utilized or will be utilized for repair or when a component's separation procedure is anticipated in the surgical plan
  • In an individual with the presence of a prior ostomy, open wounds, or exposed draining fistula(ae) from infected mesh


 

This is only a notification of the policy that will be in effect on 02/03/2014. For the current version of this policy, click the following link: 11.08.06f Abdominoplasty and/or Panniculectomy

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