Empire BC&BS of NY and Tummy tuck.. do they cover?

HI,
I have lost more than 120 pounds and want to get a TT done ( panni removal). I wanted to know if anyone know if Empire BC&BS of NY covers it and what are their requirements. I dont have any rashes but the loose skin is too much of a problem. It is giving me constant back and lower abdomen pain. I just want to get it removed to I can feel better about myself.
Thanks

I had Empire BC &BS of NY and they did cover my panni removal after an appeal. Their initial requirements are that you have to be 18 months Post-Op, have a stable weight for 6 months, documented skin rashes, panni hanging over the mons area. If you call them they should be able to tell you all the requirements, those are just some I remember off the top of my head.

That being said, I was only 14 months post op, did have a stable weight for about 6 months. I never had any skin rashes. However I did call before my procedure and was told to just have it done and submit it, they never told me the requirements I listed above. I also mentionted in my appeal that the excess skin did hang below the mons area, was causing back problems, hindering my exercise that was inperative for keeping the weight off, causing pain at the hernia repair that was done by my belly button. In addition I did get cycsts in the mons area from the excess skin pressing there. My Dr. also sent in information stating the skin was deteriorating and the procedure was medically necessary.

All you can do is try and if denied, appeal the decision. Good Luck.

Sonya
 

Thank you so much for the information. I will certainly call them and get their requirements.

A panniculectomy and a tummy tuck are two entirely different surgeries.  The panni removal only removes excess skin below the belly button and does not include any muscle tightening whereas the tummy tuck will remove excess skin above the belly button and tightens the primary abdominal muscle.

Most insurtnace companies require dpocumenbted rashes in order to approve a panniculectomy.  You should be able to find their requirements online. If not, call them and ask for a copy of their requirements for medical necessity.  Note that neither Aetna notr BC/BS of Illinois (I don;t know about Empire BC/BS) will NOT consider back or abdominal pain as criteria for medical necessity because there is no evidence that just excess skin (whihc weighs very little) is the cause of the pain.

Good luck.

Lora

Thank you for the information.  I was not sure what a Panni removal and tummy tuck is. I just wish they covered it ...the hanging skin is such a nuisance. Will check with the inusurance.