Anthem Insurance and Tummy Tuck

Hey all! Anyone with Anthem BC/BS who was approved for a tummy tuck? I work for the State of CT. and that is my insurance and I was wondering what my chances are. Thank you! Kristin RNY 2/15/05 376/228/ ? -148lbs

Hi Kristen, First, i love your new pic! You are soo pretty! Second, I have Anthem bc/bs and it is I beleive that same as yours becuase my hubby works for the City of Milford, I think the state and municipals have the same, but anyway, I am in the process of seeing if my Tummy tuck will be approved for January. I will let you know what happens , but this is what i have been told so far: The insurance usually covers the "panniculectimy" part of the tummy tuck which is from the belly button below and anything above the belly button is considered cosmetic and they will not cover the full abdominoplasty, which is what i am gettin becuase I need it very badly. So, I am waiting to hear, I will have to pay 6000.00 for the surgery this is with insurance covering the panni part of it. The whole surgery is around 12000. I am keeping my fingers crossed as well you never know they ,may pay for the whole thing. Also, if you have a problem with rashes or any back pain from the extra skin, it is a good idea to get documentation from dr..I'll keep you posted once I hear for myself from my insurance! Take care and keep up the great work! ~MaryJo~

BC/BS is great about approving tummy tucks as long as you follow their requirements...1. you must be at least 18 months post-op. 2. you have to have lost at least 100 lbs. 3. you must be at a stable weight (they don't care if you are still losing a lb here and there but they don't want to see gains or huge losses). 4. when its submitted they want to see in color pictures that show the front view, a side view and the underneth of the pannus. This is not the time for being modest! They also want the last 6 months or so of office notes and any notes from a non-surgeon (like you GYN or PCP) stating you are having rashes, discomfort, pain or any other problems due to the pannus. I've submitted roughly 100 patients (that had BC/BS) and the only ones that were turned down were the ones that didn't have the 4 requirements. It takes them awhile to make a decision but they typically approve it. Hope this helps, Jessica

HI Jessica! Thanks so much for the info. BCBS has been really good! The only thing I don't actually have on you list there is the actual dcoumnetitaions of rashes I have been getting. But my panni is really heavy and hanging low and dr. took lots of pics. Do u think they would still approve it or should I ask if you have seen them approve it without documents without other dr.'s involved. I actually have an appt. with my skin dr. becuase I do have a bad rash and they are getting worse. Thanks for all the info! My friend Bethany is having her surgery tomorrow with Dr. Barba's staff. I am soo excited for her! I am her angel! Thanks again for your info! MaryJo

HI Kristen~ I just my approval letter for my panniculetimy/tummy tuck from BCBS, I called the surgeon but they had already left, i wanted to know if this was for the full abdominoplasty or not. I will let you know more info as I get it. Just very excited. If it is only the panni they pay for then I will have to pay 7000 out of pocket for the full abdominoplasty, but it is better than paying the 12 or 13000 it costs for the full thing. Any bit helps. BUT, BCBS was awesome, they didnt give any trouble as long as you have lost 100 pounds, been stable weight for a few months, and are 18 months post -op I dont see any probs for you, I didnt even start getting documentation for my rashes yet, and they still approved me, I did take pics of the rashes but they did not need them only the pics the dr took. I'll keep u updated! My surgery date is DECEMBER 30th! Happy new year to me! Take care, MaryJo