BCBS of IL PS question

Hi everyone! I'm a california girl, but I recently got BCBS of IL PPO insurance. Has anyone had success getting any PS approved from them? I don't need everything approved, but I would like something approved so I can just convert to a thigh lift and a TT, if they will only approve a panni. If anyone has had success with this, could you let me know what steps you took? Did you see your primary first to establish rashes or anything, or did you just go to the surgeon? Thanks sooooo much! Shannon

I have not had any success with them even for my surgery. But a co-worker and I were looking into PS and found this on the website. It is thier policy regarding coverage - so if you meet the guidelines, they should pay! (however-I meet the guidelines for RNY, but they still are not paying, so good luck with them!) http://medicalpolicy.hcsc.net/medpolicies/home?corpEntCd=IL1&path=templatedata\medpolicies\surg\data\SUR716.002_2004-07-01&ctype=MEDPOLICIES-POLICY&cat=SURGERY#hlink Coverage: Abdominoplasty (which may include performance of panniculectomy) is considered reconstructive and medically necessary when clinical documentation supports the following criteria: * Panniculus hangs to or below the level of the pubis; AND * The panniculus causes chronic intertrigo that consistently reoccurs or remains refractory to appropriate medical therapy that includes systemic antibiotics, topical anti-infectives, anti-inflammatory medication and appropriate skin hygiene. Repair of diastasis recti (separation of the rectus muscles of the abdominal wall) is considered not medically necessary, except in the presence of a true midline hernia (ventral or umbilical). patty

Oh my god... I am sooooo sorry! I read your profile and I can't believe what you've gone through! I had Blue Cross of California when I had my surgery and they approved me the first time out with no further documentation. I can't believe BCBS of IL is so horrible compared! I hope everything works out for you eventually, no matter which direction you take. Thank you so much for writing me back.

Hi Patty ... I feel so bad for the crap you've had to put up with. I skimmed your profile ... do you have co-morbidities? If so, it shouldn't matter if you fall below a 40 bmi then. I can't help but think if my surgeon hadn't appealed on my behalf that this was a medical necessity (although my bmi was 53.1), I probably would be going through a lot of what you did as well. Have you asked your surgeon to appeal? I just think the insurance companies put a little more weight into a surgeon's opinion rather than a patients ... not sure, but that's the impression I get. I wish you well ... hopefully everything will work out the way its supposed to. (sheesh, did you see the new "rules" on medicare? I haven't looked too closely, but I'm thinking anyone that wants the surgery should just get hooked up with medicare?) Take care and best of luck to you Patty, Karyn

Thanks Karyn! I DO have comorbs - but my insurance co does not "recognize" them! (just another chapter in the book) For instance - for them to consider me diabetic - my Fasting blood sugar has to be 140. It is only 136! They do not think my sleep apena is bad enough either - so they do not say I have the comorbs. My doctor has not filed anything and I do think that is a big part of the problem. Since he is not a "bariatric surgeon" his office really does not know what to do for me. IF i decide to pursue this - I will more than likely be switching doctors to a recogonized center of excellance. I think that might make the process go much smoother. Hopefully the new medicade rules will pave the way for private insurance to have better policies- but who knows! Thanks for the good vibes - I really need them!