Personal Choice Blue Cross/Sheild Pays for Reconstructive After WLS ...WHAT??????

So, I got a call from Barix today asking how I am doing after my 1 year WLS surgery...blah blah. Then she asks me have I thought about reconstructive surgery. I said, "yes, but my insurance won't cover it right?" She says, "Oh you have Personal Choice...they are very good about covering the surgery. They usually cover a tummy tuck and a breast lift." I say, "Oh my gosh really!" She says, "Well it depends on how much hanging skin you have...but yeah. Ask Dr. Boe to check you and discuss it when you go in for your one year check up." Well my one year check up is on July 15th and I have plenty of hanging skin! Can this really be possible? I really didn't think insurance would cover what I believe they would think of as cosmetic surgery. Has anyone ever heard of this w/o having significant skin abcess etc. issues?? Also, if you had it done how bad is the pain factor?

Thanks a bunch,

Kathy,
I think your insurance has to have the benefit where they will cover cosmetic/reconstructive surgery. I had my PS consult in December 2008 and Dr. Lam told me that your skin would have to hang below your pubic area for them to cover it. Good luck in getting it covered though. I wish you much luck. I would be at goal if they had covered mine.

Thanks.....good luck I could really use!!!

I had gotten the same call and info from Barix, right after I had a plastic surgery consult.  Shilpa is right---your skin has to hang below your pubic area, and you also have to have issues that haven't responded to any other treatment for something like 6 months.  I have Personal Choice and haven't talked to them about cosmetics, but the doc told me they only pay if you meet those 2 criteria.  And they only pay to take care of the panni, not the upper part of your tummy.  Sorry to be the bearer of bad news.  

Anyone know what Barix ball park estimate is for a lower tummy tuck with no insurance?

Cindy,
Dr. Lam who performs PS surgery for WLS patients of Barix gave me an estimate of $12,500 for both breast and tummy tuck that would include everything but that was in 2008. Barix fees and anesthesiologist. I thought he was the cheapest around and I liked him. Too bad I don't have the money right now to pay for it. Oh B****hey finance for up to 3 years if your credit is good and I think you can use those points you accumulate on Capital One credit card as frequent flyer miles. I really liked that idea.