Insurance Question

I am around half to 2/3rds done with my weight loss and have already started have issues with recurrent skin candidiasis.  I have started looking into plastics.  I have BCBS of MI as my insurance provider.  I have called them to see if they cover plastics, and on my policy they do if it is "Medically Necessary".  They were a bit vague on the approval process and all I could get is that it is handled on a "case by case" basis.

My question is this:  Have any of you gone through an approval process with BCBS and what was required?  How long did the approval take?  Did you have to submit photos?

Any information would be appreciated.  Thanks in advance,.

I also have BCBS of MI. I just had my extended TT (5 weeks ago) which was paid for by insurance because my pannus hangs down and I had lost over 100 pounds. Either one of those things would have been enough for them to cover the surgery. I had both. The surgeon didnt even need to wait for them to approve it. I could have scheduled surgery the day of my first consult. To be clear, though, they didn't cover the "extended" part (the additional verical incision), so I paid 900 out of pocket to get the vertical...

The surgeon DID take photos to submit to insurance, but there was no approval process...

 Thanks for the information.  It is very nice of you and I appreciate it.  BCBS of MI was great on my sleeve so I was hoping they'd be cool on the plastics.  Sounds like they are.  I don't want o be pending 90 a month for crime to prevent rashes under my panni for life!

I shower twice a day, but sweat o much when I walk and work outside.  The plastics seem to b the best option.

Get to your primary care ASAP! Get it documented that you are having issues
with infections and rashes. Make sure your doctor is documenting it.

BCBS does have criteria that they told me "they cant tell me" What!!! I had to
submit a preAuth with a surgeon before they would give me the criteria. 

This is what I learned

18 months out from surgery
consistent weight (not sure how long though)
skin infections/ 4 months worth not responding to treatment
skin that hangs 2 inches below groin

This is only for the t.t. so I can only give you information on what I know.

I will keep my fingers crossed for you. Do the same for me please?

Dani

I have Anthem Blue Cross of Connecticut and they paid for my tummy tuck.  I had extensive hernia repair done as well.  My doctor took pictures (UHG!!!!!!!) of my panni which hung halfway down my thighs and made the case that my panni would compromise my hernia repairs.  I also wrote a letter detailing how it has affected my daily functioning (movement, excercise, hygiene, back pain, rashes, intimacy etc...).  They approved it in 3 days.

I hope that helps.