BCBS MI said they'd cover a tummy tuck or panni...

Had anyone ever heard of such a thing?
I have been making my appts to see surgeons so I got the proceedure codes-
panni- 15830
tummy tuck- 15847
with the diagnosis codes- 695.89 and 729.30
I called my insurance and we went over everything, looks like I meet the criteria, and it sounded like it'd be covered for either procedure? How can that be? Anyone have any info on that? 

BCBS does not pre-authorize, so I'd have to pay the surgeon fee up front, they they'd reimburse me.

I called the surgeons office back and they said they've never heard of that either.

I'd appreciate any input... thanks!

Lisa

I had a BR/BL done in May.

I have BCBS Fed and they don't pre-authorize either, but I never had to pay anything up front other than my co-pays for my policy ($100 to hospital and $75 to dr.)  I don't understand why you would have to pay the surgeon fee up front???  If this is a covered procedure (has to be medically necessary), and they have verified this, why wouldn't they bill your insurance and if something happens that they don't pay (1st they appeal), worse case scenario, you would then pay the surgeon fee.  I don't think you should have to pay the surgeon fee upfront.  Is that something in the policy?  Or is this something in the PS policies?

Debbie

I believe it's the PS policy since BCBS won't pre-authorize. We'd be reimbursed after they pay.
Did you have panni removal or TT?

Hello,
I have BCBS of Illionois and i have had several surgeons ask for me to pay up fornt fees. One explained that although it was deemed medically necessary and a letter of Pre-determination was sent on the botto of the letter it reads THIS IS NOT A GUARANTEE OF PAYMENT. So the surgeon said that the insurance at times would refuse to pay afterwards.

Are you getting a TT or panni removal? Will they cover either for you?

I've never heard of an insurance company covering a TT

Ooooo, lIsa! Gonna get a bikini tummy!! Yay!!! for you!

Oh Barb,

You'll never see me in a bikini!!!

Thanks for the cheering... you are TOO funny!!

Lisa

Tummy tuck is covered. The first time my papers were submitted the dr used code 15830-panni, I called and gave them the other code 15847-Tummy Tuck and got the pre determination saying t was covered. I've actually upgraded to a LBL and I am paying the difference in cost.

Good deal for you! Best wishes for your surgery!

Lisa

I have BCBS-HMO IL and they're paying for the LBL, BL/BR, brachioplasty, and thigh lift. According to my surgeon, it's all in how the letters of medical necessity are written and the photos documenting the damage.

We were really surprised - figured they'd cover the panni and BL/BR only (I have a torn muscle behind it from the swinging empty skin), but they did it all after it was explained that just the BR/BL would leave too much skin on my sides pulling on that muscle and tearing it again, so the arms got covered. Then the letter about the LBL specified that there would be no way to avoid worsening the back skin (i.e., I'd wind up with "footballs" on my hips) unless they did circumferential, so that got approved. We have no idea how they decided to ok the thighs as well, but I'm certainly not arguing!

My gyne breast specialist and the surgeon told me that the HMO is easier to get things approved through than the PPO.