Insurance Question...
I have a question regarding insurance approval for a tummy tuck and possibily a brest reduction...I had RNY gastric bypass surgery in November of '08 and to date have lost 110 pounds. While I couldn't be happier with my weight loss, it has left me with what seems like a TON of excess, saggy & baggy skin all over my body. I have Care First/Blue Choice insurance and while they do cover plastic surgery, they will do so ONLY if it is deemed "medically necessary". Aside from having A TON of sagging skin, I haven't really had any of the symptoms that they say I'm supposed to have in order to make even the TT a medical necessity ( skin lesions, severe rashes, infections, etc...). Please don't get me wrong--I'm happy that I've pretty much been symptom free, but unless my insurance can cover the bulk of the medical bills relating to a TT, breast reduction, etc...I won't be able to get anything done. Besides raising 3 very active (& expensive..lol) children, we are a one income household, so we just don't have the $$ to be able to pay for these surgeries.
I was wondering if anyone else was/has been in my situation, and if so, were you able to find a way to get the insurance approval(s)? Does anyone else have Care First/Blue and if so, how hard has it been to get surgical approvals? Our insurance just switched from One Net to Care First Jan 1, 2010 so I haven't had much experience with them yet...Any suggestion, thoughts, etc that you all could send my way would be very much appreciated!
Thank you all so much!!! ~Jenna M.
I was wondering if anyone else was/has been in my situation, and if so, were you able to find a way to get the insurance approval(s)? Does anyone else have Care First/Blue and if so, how hard has it been to get surgical approvals? Our insurance just switched from One Net to Care First Jan 1, 2010 so I haven't had much experience with them yet...Any suggestion, thoughts, etc that you all could send my way would be very much appreciated!
Thank you all so much!!! ~Jenna M.
You need to find a surgeon who is willing to work with you. I had the RNY in 07 and I'm going in a few weeks for a breast reduction and tummy tuck.
I don't have the same insurance as you however my surgeon did get the breast reduction approved along with a panniculectomy (removal of the excess skin) I'm just paying extra for the full tummy tuck which will include lipo and shaping as well as sewing the abdominal muscles.
The MOST important thing to do is to make a list of all the things that bother you about the breasts and skin before you see the surgeon.
Mainly tell the surgeon how uncomfortable the skin is, how you sweat in those areas and that clothes do not fit properly. I had loss of feeling and it would get pinched when I wore certain clothing...tell him everything.
When it comes to the breasts tell him you have to buy the special bras with the padded shoulder straps, neck strain, back pain, tenderness, etc.
Have you talked to the surgeon that did the RNY? I used Dr. Gary Harrington for the RNY and he also does tummy tucks. His office is wonderful when working with insurance companies. I was approve on the first try for the RNY. Unfortunately I am now living in GA and had to use a doctor here but if I were back in MD I would definitely go back to Dr. Harrington- he is wonderful!!
I wish you the best of luck.
Please let me know if I can be of further assistance.
I don't have the same insurance as you however my surgeon did get the breast reduction approved along with a panniculectomy (removal of the excess skin) I'm just paying extra for the full tummy tuck which will include lipo and shaping as well as sewing the abdominal muscles.
The MOST important thing to do is to make a list of all the things that bother you about the breasts and skin before you see the surgeon.
Mainly tell the surgeon how uncomfortable the skin is, how you sweat in those areas and that clothes do not fit properly. I had loss of feeling and it would get pinched when I wore certain clothing...tell him everything.
When it comes to the breasts tell him you have to buy the special bras with the padded shoulder straps, neck strain, back pain, tenderness, etc.
Have you talked to the surgeon that did the RNY? I used Dr. Gary Harrington for the RNY and he also does tummy tucks. His office is wonderful when working with insurance companies. I was approve on the first try for the RNY. Unfortunately I am now living in GA and had to use a doctor here but if I were back in MD I would definitely go back to Dr. Harrington- he is wonderful!!
I wish you the best of luck.
Please let me know if I can be of further assistance.
Look at the articles Dr. Lomonaco has written on insurance approval. http://www.drlomonaco.com/about-houston-cosmetic-surgery.sht ml You will find them under the patient resource tab.
Red
Red
Most Active
Recent Topics
