Loquacious Laura (Laura Crowe)

Waiting on Pre-Authorization for Plastics

Jun 29, 2011

 Lots of insurance companies do cover plastics after weight loss surgery. They must be medically necessary so have your pcp write a referral to a surgeon, Have your pcp document any issues related to the loose skin...rashes (keep receipts for creams too) or neck and back pain, etc. photos of the rashes are very helpful in getting approvals. Do not refer to it as plastics or cosmetic surgery, it is body contouring after massive weight loss. 

I went to a plastic surgeon Thursday and now waiting for pre-authorization from my insurance co for plastics. Passing along the cpt codes... you can call your ins co and ask if the codes are covered...if you ask about the procedures the operators always say no cause they don't know any better. Mastoplexy (breast lift) "cpt code 19316", Brachioplasty (arm lift) "cpt code 15836", Thigh lift "cpt code 15823", Panniculectomy (tummy tuck w/no muscle reconstruction) "cpt code 15830".  Again don't call there and ask "is plastic surgery covered" the operators are not the ones who know...they simply are call center operators that can relay info from your file or their computer and can change pcp, address, etc info in your account. They are not experts they use a intranet to search for the answers to your questions. A middle man so to speak. They do not make the decisions they can pretty much only change your pcp or give you info based on what is in your file. Pretty much all you do is call get a rep and say "i am interested in finding out if some procedures are covered, i have the CPT codes" They will be more than happy to give you the answers because you have done half the work by having the CPT codes ready for them. Let me know how it goes. Be sure to ask the % covered some are 80/20 mine is 100% with a $250 co pay after my high deductible is met which it is my daughters are having their tonsils removed this year.

I am pursuing brachioplasty and mastoplexy and my surgeon is going to zig zag the scar in my armpit so he can pull the bra back skin into it and make it one long scar from my inner elbow into my armpit and down under my breast and up to center so it's back breast and arm all at one time. One procedure one long scar on either side which i am fine with. better than 3 different procedures.


Once i have that surgery I will get approval for the others.  one at a time...

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