If you have BC/BS and you're planning plastic surgery...

Just a heads up for anyone that has health insurance through Blue Cross/Blue Shield of NJ and you either have been approved or will be attempting to get approval. I had a TT and BR/BL in November. I was pre-approved by BC/BS for both procedures and they did pay the doctor. I saw him today for routine follow up and was told that they are having problems with BC/BS. They have been denied payment on 5 patients that were pre-approved (all code numbers in place) by BC/BS. In two of the cases the individual's policy did not cover any PS but BC/BS did not realize that until post op. In each BC/BS is telling the PS to go after the patient for payment. So...I would highly recommend if you have BC/BS coverage you have copies of all approval numbers, names of people you spoke with, etc if you planning any elective services. Good luck. Wilma

Thank you for the heads up!!!  I have BCBS.  Do you mind if i ask you what plan you have?  I know i am going to need PS in the future.  I know the insurance does pick it up if it is deemed medically necessary and if you lose more than a 100 pds.  Was it an easy process for you? How long did it take to get approved?  Thanks for the info.....Christine

Hi Christine. I have NJ Plus which is administered by Horizon BC/BS. I never had any problems with them and I've had many surgical and post op procedures - most not related to the WLS or PS. The process of getting approved for PS took about 5 - 6 mons since they wanted more and more in terms of support for medical need. I was in no rush so I didn't see it as a problem. I was lucky - no problem with rashes - but I had photos taken by the PS along with letters from my primary physician, the physician that did the weight loss surgery and finally a letter from an orthopedist who was just dumb founded that they felt we could offer me something to help with the hanging stomach and boobs. I'm a nurse and they taught us in school "DOCUMENT, DOCUMENT, DOCUMENT" and I think you need to do the same thing when you're ready to start the next quest. Good luck. This whole thing, whether you have PS or not, will be the best gift you could give to yourself. Wilma

Thanks so much for the advice... and i will be taking it. Thanks again.   Christine.

dumb question?? what is a PS?? I have blue cross blue shield...they paid for everything, even the psych exam.

PS = plastic surgery

ha ha ha silly me. I have been out of the loop for so long I forgot the lingo!!!!!  Thats for the update!! 

wILMA,

 i WAS WORRIED ABOUT THE INSURANCE AND MY DRFRANK BORAO SAID IF YOU LOOSEV OVER 100 POUNDS AND MOST OF US HAS IT IS CONSIDERED RECONSTRUCTIVE AND THE INSURANCE HAS TO PAY FOR PLASTICS. MINE DID QUAL CARE PPO.  YOU JUST HAVE TO HAVE THE RIGHT DOCTOR OFFICE GOING TO THE INSURANCE COMPANMY. I USED DR MICHAEL ROSE WITH DR ELKWOOD IN SHREWSNURY THEY ARE REALLY GREAT AND ALL I HAD TO PAY OUR OF POCKET WAS FOR MY BREAST IMPLANTS $750.00 THE REST QUAL CARE PAID FOR  SO GO ADFTER THEM ASK FOR YOUR EMPLOYER BENIFITS SPECIALIST TO GET ENVOLVED MERIDIAN HEALTH GAL DID AND ALL OF MINEWAS PAID AT INNER CIRCLE PRICES AND WITH A GREAT PLASTIC GUY SO DON'T GIVE UP! I HAVE TO HAVE MY ARMS TWEAKED AGAIN BUT THEY WERE HUGE SO I KNEW GOING IN THERE WOULD BE TWO SURGRIES FOR THE BAT WINGS IF YOU HAVE MORE QUESTIONS LET ME KNOW GOOD LUCK

JOYCE

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Thank you for responding to this email. I've already had all my surgeries. This was a warning to others who have not. BC/BS has been creating havoc for a lot of people - regardless of medical need. I personally know of three people who were approved, had dates for surgery, authorization codes, etc and wound up with calls the day before saying they were denied or surgery was done and then the surgeon was denied payment. Someone that works with me had a date for the lap band procedure on 5/30. On 5/29 she was told they wanted more documentation to support her having the procedure. The fact that she is diabetic and had a stroke related to her high blood pressure was not enough. Again this was after she had approval and the doctor's office had authorization codes.  I don't know if this applies to other health plans but I KNOW it applies to all BC/BS plans so people need to be aware they may have problems if they have BC/BS coverage. Wilma