Question:
abdominoplasty, scar revision, breast lift, augmentation

I have Bluecross/Blueshield personal choice of Ga. I was looking at coverage. And read that the procedures above are covered with precertification. Has anyone been successful in having insurance pay for these. I have a lot of irritatation, rashes, itching, from hanging skin. I am 9 months out. Thanks for your help! Lesleigh    — lesleigh07 (posted on August 31, 2008)

August 31, 2008
I would like to know the answer to this too. But im in Cali
   — urbrat2

August 31, 2008
Hi, I know people that have had the repairs done as it was medically neccssary due to Dr. noted irritations from the hanging skin. It is worth a try~ Your primary DR. should be able to help you with knowing what the requirements and bulid a case from there.
   — tootsie52

August 31, 2008
Lesleigh, Hey there and congrats on having lost enough weight to cause the nagging skin hanging all over. I feel your pain sister. When I reach goal, I will have lost around 252# and will have to have EVERYTHING sucked, tucked, nipped, cut, lifted, whatever you get the picture. I just know all of mine will be out of pocket. I'm saving now. I am an RN and used to work for an insurance agency precertifying these exact procedures based on the Plan guidelines of coverage (what is says in your BCBS handbook) and medical necessity. Not BCBS by the way. You do have to jump through the hoops if you want insurance to pay for them ie: having the doctor document and/or photo the rashes and the exact treatment. Photos go a long way... don't worry, they don't put your face in it. It should be documented how this hanging skin has adversely effected your life- embarrassment, unable to be intimate with your partner, back pain, repeated rashes with treatment, etc. Don't forget the emotional aspects for sure. If I as a nurse couldn't approve the procedures, I forwarded it to an MD for review for the final say. Different insurance plans require different information. I would recommend this: call your insurance company's 1-800 number and ask exactly who will be reviewing your submission and/or ask to speak with a nurse directly. He/She should be able to answer all of your questions and might even be nice enough to give you their name, direct extension and fax number. I would encourage all of my patients to mail and fax requests. I would also give them the actual address of the building I was in, not the central office address, and ask they mail their submittal and photos to me with "Personal and Confidential" written boldly on the envelope so that no one could open the envelope in the mailroom, JUST me. Less chance of things getting lost/delayed this way. Not everyone is willing to do it this way, it is good customer service though. I have to be completely honest, I have never had good dealings with BCBS, but I live in Florida and all WLS and resulting plastics are (or at least were) Plan Exclusions. Don't get me started on that though. I'm about $20,000 in so far. I wish you the best of luck, Dawn Vickers, RN, BLC, CLC
   — DawnVic

August 31, 2008
I have BC/BS of TN and they paid every penny of my tummy tuck simply by looking at my pictures. Mine was really not that bad but I wanted it gone, so the nurse took the pictures and within 30 days they said they would pay for it. As for the lift and augmentation, I don't know but they certainly paid for my tummy!!!
   — CAMFR

September 1, 2008
As far as the hanging tummy skin I HEARD that if you have 3 skin infections in 12 months (be sure you go see a doctor to get it documented) then it may be covered. Good Luck.
   — nancycarle

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