blue cross and blue shield anthiem-Panni Removal

Does anyone know anyone in the area of Edwardsville or St Louis that deals with this I still have weight to loose, but the skin is breaking down so bad and hangs so bad I have to get it off. Thanks

I'm not from or in your area; however, I have the same insurance and with complete documentation of rashes and infections, the insurance company approved my panniculectomy without hesitation the very first time the paperwork was submitted.  I wish you the best at getting your approval.

Always,
Rose

Thanks I was denied once several months ago, but I didn't have the medical records or pics for the rashes and infections. I finally got a copy of them they have been going on since before my surgery.

I had BCBS Anthem, but in a different state.  They did cover my panni.  I needed to maintain at a  steady weight for 6 months, panni needed to hang at least 2 in below top of pubic bone and documented rashed. I couldn't get a straight answer from insurance of what the criteria was, I actually went to the website and searched till I found it.
Good Luck

wha t do I look under and thanks so very much.

Here are the requirements for Anthem BCBS for an Panni removal.   You need to have documentation from either your surgeon or PCP of documented rashes, and flare up and medication prescribed for them and the documentation of the non response to the treatment.  You will need pictures

Medically Necessary:

Panniculectomy is considered medically necessary for the individual who meets the following criteria:

1. The panniculus hangs below the level of the pubis (which is documented in photographs); AND
2. The individual has achieved significant weight loss and reached a body mass index (BMI) ≤ 30 kg/m², as well as the following:
   • the individual has maintained a stable weight for at least six months; AND
   • if the individual has had bariatric surgery, he/she is at least 18 months post operative; AND
3. One of the following:
   • there are recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers, that do not respond to conventional treatment for a period of 3 months; information must be documented in office visit records; OR
   • there is difficulty with ambulation and interference with the activities of daily living; information must be documented in office visit records. 

Panniculectomy is considered medically necessary as an adjunct to a medically necessary surgery when needed for exposure in extraordinary cir****tances. 

Not Medically Necessary: 

Panniculectomy is considered not medically necessary when the criteria above are not met.

Panniculectomy is considered not medically necessary as an adjunct to other medically necessary procedures, including, but not limited to, hysterectomy, and/or incisional or ventral hernia repair unless the criteria above are met.

Panniculectomy or abdominoplasty, with or without diastasis recti repair, for the treatment of back pain is considered not medically necessary.  

Cosmetic and Not Medically Necessary:

Liposuction is considered cosmetic and not medically necessary for all indications. 

Abdominoplasty when done to remove excess skin or fat with or without tightening of the underlying muscles is considered cosmetic and not medically necessary.

Repair of diastasis recti is considered cosmetic and not medically necessary for all indications

I just went to different sections of web site and searched panniculectomy, I think I found it in the physician part.
Good Luck