Insurance Question

I am interested in TT or Panni.  I contacted my INS & they said with medical justification, they will cover it.  I contacted PS who is contracted with my INS company & on OH list of PS. They basically told me that INS doesn't cover under any cir****tances.  Does this sound right?

 

No, that does not sound right. I'm scheduled for the panni removal and TT on June 10th and the insurance is paying for both. It VERY unusual for insurance to pay for the TT but unless however the panni removal may be if it meets the criteria for being medically necessary. You may have to ask insurance for a copy of that policy, and actually my PS office had a copy of the policy as well. I have a very common insurance that my PS office is familiar with so that is why they had the medical policy info. Customer service will say 'if medically necessary' but there should be a policy available to you that is very specific. You will need to ask for the medical policy as it relates to plastic surgery. For example...my insurance required that I be 1 yr out of surgery, weight loss of 100lb or more, documented treatment of skin issues such as rashes. 
Hope that helps some!

Sorry if this is too personal, but what type of insurance do you have? I'm under humana, and work at a hospital, so I'm hoping to get some chance of coverage. Thanks!

Hi Amanda, Not too personal at all. I have Blue Cross Blue Shield of GA HMO. We are owned by Anthem. The funny thing about insurance is that even if you had BCBS it could be different from mine. It all depends on what your company picks as part of their coverage and what is offered by the plan.
Good luck!!

I had trouble finding a surgeon that would accept insurance for the TT.  I contacted several surgeons who were in network and they all said the same thing.  I think that many times the PS are contracted and will accept insurance for other reconstructive surgery but not this.  I am not sure why that is -- but it is the reality.  What I did was expand my search to the next large city in my area and eventually I did find a surgeon who was willing to work with my insurance, he is about 100 miles away.  Just keep looking.  You might also contact bariatric surgeons in your area to see who to whom they refer patients.

Red

I have Blue Shield of California PPO (Anthem).

They paid my entire DS - even thougth my surgeon was out of network! I work at a Dr.s office, but do billing for Medi-Cal,Medicare & all gov't funded ins.    So, my private ins experience is nill.


Thank you for your advise.  I will contact my insurance & get specific requirements!