MESSA BC/BS Hernia Repair/Tummy Tuck/Panni Coverage?

Julie R.
on 6/25/13 12:06 am - Ludington, MI

Hello all!   I am seven years post-op duodenal switch, and have just been diagnosed with a ventral hernia.   My surgeon has suggested that I try to see if my insurance will cover abominoplasty and panniculectomy, since he is also going to be doing the hernia repair.   I have MESSA (Michigan teachers) Blue Cross/Blue Shield.   Has anybody had experience with them, and did they cover your procedures?   I do not have a very large panni, but my surgeon stated that oftentimes, they base their decision not so much on the overhang of the pannus, but how much weight you have lost (146 pounds).   Thanks!

Julie R - Ludington, Michigan
Duodenal Switch 08/09/06 - Dr. Paul Kemmeter, Grand Rapids, Michigan
HW: 282 - 5'4"
SW: 268
GW: 135
CW: 125

Mell
on 6/25/13 1:14 am

I do not have it but I remember I found my insurance requirements with google...Here is what i found for you.

http://www.michigan.gov/documents/lara/BCBSM_-_123006_-_Medi cal_Necessity_Reconstructive_Surgery_377446_7.pdf

Good luck

Mell
Start weight: 320
At surgery:  300
Current:      185
Goal:           175

Julie R.
on 6/25/13 2:50 am - Ludington, MI

Hi Mell, thank you!  I did see that one, and hope that they do approve coverage of my panniculectomy.   My panni is really pretty small, but in another document, I think the determining criteria is that you have to have lost more than 100 pounds, so I am hoping that they do not base it on size.   

Julie R - Ludington, Michigan
Duodenal Switch 08/09/06 - Dr. Paul Kemmeter, Grand Rapids, Michigan
HW: 282 - 5'4"
SW: 268
GW: 135
CW: 125

alla B.
on 6/25/13 1:23 am

Hi Julie,

Nice to see you in the plastic board!

i do not have BCBS, my insurance is oxford and they paid for my TT.

i just want say welcome!

 

Alla

PART 1 VSG  03/28/2006;  PART 2   DS  01/31/20007

Julie R.
on 6/25/13 2:48 am - Ludington, MI

Alla!  How are you doing?   I am doing great!  Holding all but less than ten pounds of my weight off, feeling great!

Julie R - Ludington, Michigan
Duodenal Switch 08/09/06 - Dr. Paul Kemmeter, Grand Rapids, Michigan
HW: 282 - 5'4"
SW: 268
GW: 135
CW: 125

alla B.
on 6/25/13 2:52 am

i am ok, lost  200lb  and holding. i did TT, breast lift and arm lift,

i think it helped me with weight loss and keeping it off as well.

good luck to you and keep us posted.

alla

PART 1 VSG  03/28/2006;  PART 2   DS  01/31/20007

momma_dee
on 6/25/13 4:44 am

The BCBS coverage varies, I had BCBS out of MS as a primary and they said they would only cover the panni surgery if a hernia was present. I didn't have one, but had a huge pannus. SO they denied and really I had no grounds to appeal. I dropped that insurance and used hubby's BCBS out of PA and after 2 appeals they approved as a reconstructive surgery and due to recurrent skin issues as well as size. They have paid 100% of hospital costs and I paid my surgeon 400$. I would think that since you have a hernia, the insurance would pay to have that repaired and if your doctor writes the request correctly such as the things contributing to the hernia-weakened muscles and strain from excess skin pulling? I would just recommend talking to your surgeon's insurance person, usually they are very helpful and can tell you what the insurance is looking for.

Crazeru
on 6/25/13 5:30 am

I know Tom Blanchard had a big hernia that he could have had fixed in the states with a panni, but he wanted everything done and went to Dr Sauceda in Monterrey Mexico.  Dr S hand sews the hernia - no mesh, then did his LBL, arms, thighs and 4 days later his upper body lift and man boobs.  Tom has pics with his Sauceda Experience then Tom - levittown_loser

http://www.obesityhelp.com/group/Dr_Sauceda_Patients/photos/

Congrats on taking the PS step.  I know that my panni didn't hang down far enough for Kaiser to do anything about it, but hopefully, BC/BS will be better.  How's your D doing now?

Chris
HW/225 - 5'1" ~ SW/205/after surgery 215 ~ CW/145~ BMI-25.8~Normal BMI 132 ~DS Dr Rabkin 4/17/08
Plastics in Monterrey - See Group on OH Dr Sauceda Jan 13, 2011
LBL, BL, small thigh lift, arms & a full facelift on 1/17/11
UBL 1/21/13
Love my Body by Sauceda

Julie R.
on 6/25/13 6:20 am - Ludington, MI

Dr. K wants to hand sew mine too.   Mine is small, but he said that the small ones can be the dangerous ones, and rather than put mesh over it, he wants to make it the "way nature intended it to be."    My D is improving!   I started taking K1 and K2 with my D regularly, and although my D still hangs out in the low normal, my PTH has dropped well over 100 points.    They are both heading in the appropriate direction.   :-)

 

Julie R - Ludington, Michigan
Duodenal Switch 08/09/06 - Dr. Paul Kemmeter, Grand Rapids, Michigan
HW: 282 - 5'4"
SW: 268
GW: 135
CW: 125

Crazeru
on 6/25/13 7:21 am

Great news on your PTH.  I had to finally add in K1 & K2 before my UBL as my PPT was high. I think hand sewn is much better.  Tom hasn't had any problems since his was fixed.   Hopefully, you won't have a fight with the hernia repair.  You may have to pay the difference from the panni to a TT, but it shouldn't be too much.  

I know that fixing the body, really helped to fix the mind too.

Chris
HW/225 - 5'1" ~ SW/205/after surgery 215 ~ CW/145~ BMI-25.8~Normal BMI 132 ~DS Dr Rabkin 4/17/08
Plastics in Monterrey - See Group on OH Dr Sauceda Jan 13, 2011
LBL, BL, small thigh lift, arms & a full facelift on 1/17/11
UBL 1/21/13
Love my Body by Sauceda

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