Keystone HPE and PS
Anyone with Keystone used them for PS lately? If so, how tough was your experience getting coverage? Is the panni strictly determined by the overhang only or must there be rashes & yeast infections? Is a BR covered (w/neck and back issues) but not the Lift or Aug? Anybody know? And, would both be done at the same time or must you do one than the other? Used to be if you did them at the same time it red-flagged for cosmetic reasons but if you did the BR first for back issues you'd then do the panni second for WLS. 2 ops is alot of OR time. I've called them and it's like talking to a wall .... nobody has answers, they go round and round with double-talk and it sounds like they are just trying to frustrate the heck out of you til you walk away....which I might, but I'd trip over my t*ts.....
Jackie J. 
1 choice @ a time > 1 day @ a time. Slow to Succeed is still Success ;-)
Hi Jackie,
It's really hard to answer your questions because approvals, denials, requirements are all on an a policy by policy basis even with the same insurance carrier.
In other words:
~You and I are both covered under Keystone
~You work for company A and I work for company B
~Your policy covers panni removal if you can show chronic rashes/infections for a minimum of 12 months and photos must be provided...That's all you need in order to get approved
~My policy only covers it if there is at least a 6 inch overhang verified by photos, rashes/infections verified by pharmacy records and doctors office visit notes and at least 6 months chiropractic care for chronic back pain due to the weight of the excess skin.
I really hope that made some sense. The last thing you need is me confusing you even more...lol.
After working for BCBS for almost 10 years, I have no doubt that you were given the run around by the customer service reps you spoke to. Most don't know their ass from their elbow and they're on production quota's so they'll always try to get you off the phone as quickly as they can and it' a shame because you're the only one who suffers when you can't get the correct information.
My suggestion is to call the plastic surgeon and ask for the billing / procedure codes they would be submitting to the insurance company for payment on. Call the insurance company back and ask to speak with a senior customer service rep. Take your time on the call, ask every question you need to until you have a crystal clear understanding of what benefits you may be entitled to for reconstructive surgery not cosmetic surgery. Write down every detail of the call including the reps name, the date and time of the call and every bit of info they're giving you. If they get pissy because you're keeping them on the call for too long, that's just too bad for them. Don't let the rep try to end the call until you are completely satisfied with the information you're being given. If you still feel that you're not getting straight forward answers then by all means ask for a supervisor and repeat the process.
Hope that helps and good luck to you!
It's really hard to answer your questions because approvals, denials, requirements are all on an a policy by policy basis even with the same insurance carrier.
In other words:
~You and I are both covered under Keystone
~You work for company A and I work for company B
~Your policy covers panni removal if you can show chronic rashes/infections for a minimum of 12 months and photos must be provided...That's all you need in order to get approved
~My policy only covers it if there is at least a 6 inch overhang verified by photos, rashes/infections verified by pharmacy records and doctors office visit notes and at least 6 months chiropractic care for chronic back pain due to the weight of the excess skin.
I really hope that made some sense. The last thing you need is me confusing you even more...lol.
After working for BCBS for almost 10 years, I have no doubt that you were given the run around by the customer service reps you spoke to. Most don't know their ass from their elbow and they're on production quota's so they'll always try to get you off the phone as quickly as they can and it' a shame because you're the only one who suffers when you can't get the correct information.
My suggestion is to call the plastic surgeon and ask for the billing / procedure codes they would be submitting to the insurance company for payment on. Call the insurance company back and ask to speak with a senior customer service rep. Take your time on the call, ask every question you need to until you have a crystal clear understanding of what benefits you may be entitled to for reconstructive surgery not cosmetic surgery. Write down every detail of the call including the reps name, the date and time of the call and every bit of info they're giving you. If they get pissy because you're keeping them on the call for too long, that's just too bad for them. Don't let the rep try to end the call until you are completely satisfied with the information you're being given. If you still feel that you're not getting straight forward answers then by all means ask for a supervisor and repeat the process.
Hope that helps and good luck to you!
Jackie
I have Keystone Health Plan East. My panni was completely covered. I didn't have rashes and this panni was not hanging to my knees as my first one was. I was approved within 3 weeks of my consult. There is a copy of the letter that i wrote and had my PCP sign. I also had my GBS surgeon fax a letter.
As far as BR, I spoke to the PS for future reference. We discussed how I was going to go about this. PM me, it is not a great secret but I am not comfortable saying it on a public forum
Insurance companies are in business to make money and denials are their claim to fame. My PS told me that if by some chance I was denied that she would go with me to the BCBS and show them in person why I needed the panni. Just keep trying.
I plan on having my knees replaced next year and then I will have my thighs done at which time I am hoping that I can get the girls reduced and perky.
Keep trying. Persistance will win out.
Jeanne
I have Keystone Health Plan East. My panni was completely covered. I didn't have rashes and this panni was not hanging to my knees as my first one was. I was approved within 3 weeks of my consult. There is a copy of the letter that i wrote and had my PCP sign. I also had my GBS surgeon fax a letter.
As far as BR, I spoke to the PS for future reference. We discussed how I was going to go about this. PM me, it is not a great secret but I am not comfortable saying it on a public forum
Insurance companies are in business to make money and denials are their claim to fame. My PS told me that if by some chance I was denied that she would go with me to the BCBS and show them in person why I needed the panni. Just keep trying.
I plan on having my knees replaced next year and then I will have my thighs done at which time I am hoping that I can get the girls reduced and perky.
Keep trying. Persistance will win out.
Jeanne
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