Getting Insurance to Pay

Every plastic surgeon's office I've spoken to so far here in St Louis (about 5) have all told me the same thing...

skin removal will never be covered under insurance.

I'm finding this SO HARD to believe.   I'm going to actually call the insurance company on Tuesday to find a surgeon in network and go from there.

I"m not expecting 100% coverage.  Realistically, I"m ready to get away from the idea that I'll ever have the skin removed since I'm unable to financially afford it all on my own.  I'm prepared to live with the skin forever, but I figured, what the hell... why not at least give it a shot and see if they will pay, right?


Anyone else experience this??

I have heard that all insurance companies are different but my doc has told me if i loose 100 lbs that my ins will pay for a tummy tuck at least. Good luck!!

All insurace companies are different. Refer to it as "reconstructive" surgery after massive weight loss when you call and you may have more luck.

Laura

Absolutely talk to your insurance about reconstruction rather than plastics. Additionally, ask your insurance company to fax/email you ANY pages in YOUR specific policy that may apply.

Then take those pages in to the coordinator at a plastic surgeon you've decided to go with, and have them submit.

The scheduler at my surgeons' office told me there was no point in submitting, because "nothing" would be covered. Everything but the vertical anchor cut was. However, a lot of that was due to other medical conditions that had arisen, but it's always worth a shot.

my company is self insured and they won't cover unless trauma or medical treatment; ie breast reconstructive after brest cancer, etc. My dr tried but it was flat denial for all I need the lbl, breast red, and inner thighs.

I just did the lbl and will do the others when I save up....

You need to get with your insurance company and find out what reconstructive surgery they do cover and what the criteria is to get coverage.  Then work on meeting that criteria.  Then when you've got all that done and documented (via medical records, which may mean you need to make a few visits to your PCP) then take the information with you to your surgeon and have them submit for approval.

I was told my at least 2 of the 4 that I consulted with that they highly doubted I'd get anything covered.  Well, I knew my policy and did everything that was required and submitted and got approved.

The key is to make sure you've got all your ducks in a row and that you've done everything required by your insurance company (and it's officially documented).

Good luck!

EXCELLENT!!!! Thank you so much ladies!!!  I appreciate all the responses, and first thing Tuesday, Anthem BCBS will be hearing from me


Take Care and have a safe and Happy 4th!!

I carry BCBS and they are pending paying for the panniculectomy only. My total cost of my tummy tuck is about $6000. My insurance may possibly cover 1500 of the total cost. I had to pay the total amount and wait to see if my insurance company will cover the possible $1500. I also had to have lost at least 100lbs, maintain my weight for at least a year, and have an overhang. All which I have. Good luck to you. I know how hard it is to want something so bad and feel like it's so far away. My husband worked alot of overtime to get my surgery paid for in two months. Best of luck!