Question:
Hhow much excess skin do you have to have before they will consider sugery?
When will Insurance cover. BCBS personal choice. — teresa M. (posted on March 1, 2003)
March 1, 2003
First, all BCBS policies are different. Now that I've said that, I just
had a panniculectomy (tummy tuck) and the doctor removed about 5 pounds of
excess skin and tissue. Personally, I was a little disappointed because he
said it would be between 15 and 25 pounds. But I am not displeased with
the results even though I would have like to have been a little flatter.
But according to the BMI charts, I'm still obese. I have lost 171 pounds
(including 11 since the tummy tuck) in 15 months and am very pleased. I am
56 years old and my surgeon didn't want me to lose below 200 (I'm now at
175) because my face is very thin and he thinks that if I lose much more, I
will look bad and feel bad. I have lost roughly 80% of my excess weight
and I am thrilled. I lost 160 pounds in about 10 months. I certainly
don't look like a 20 year old model, but I am at least "normal"
looking now.
You will need to check with your insurance company about their requirements
for considerting the skin removal medically necessary. Mine (Empire Blue
Cross) denied it at first as cosmetic, but after my surgeon spoke with
their doctor, they reversed it.
Good luck to you.
— Patty_Butler
March 1, 2003
It's not really an issue of *how much* extra skin you have with most
insurance companies. It's an issue of whether you can prove the removal of
the extra skin is medically necessary. Typically, you will need to prove
with the concurrence of your doctors, that it is causing uncontrollable
skin problems (rashes), or pain of some sort, and that it cannot be
controlled in any other medical manner. I think the one exception here is
breast reduction surgery, and if there is a certain amount of breast tissue
to be removed, then that is a qualification for the surgery (not sure what
it is - 500 cc??). In my case, I went through multiple appeals proving
that I had suffered from some pretty severe back pain and had taken a
number of other steps to try and resolve it, including medication and
physical therapy. -Kate-
— kateseidel
March 3, 2003
Have the doctor take a side photo of you pulling all your excess skin out.
This REALLY shows how much excess skin you really have. I was approved the
same day once the insurance company saw that picture.
— Patty H.
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