Tummy Tuck

I am 3 1/2 years out of Gastric ByPass Surgery. I am down and maintained it 64 of the 94 I wanted to lose. I was 244, now 180 and wanted to be about 150. I am about 30 pounds of my goal. I am back at it seriously but wanted to make sure I was about to maintain a good weight loss amount before I kept going. With stresses in my life at the last 3 years. I was good to maintain it. I think.

Anyways, does anyone know what the standard is on when they will approve or not approve the tummy tuck based on weight, etc? Aside from the insurance. Will insurance companies approve it, if the surgeon deems it necessary? 2 questions, here.. Help. Need to know what I need to do physically to get approved.

What you need to look at is if your insurance policy even covers panniculectomy and/or TT.  Many insurances will not cover a TT. I have BCBS and they covered both.

My advice is to find out if they do and what their specif criteria is.  for BCBSTX the criteria for medical necessity included a pannus that hung to the pubis and recurrent rashes or skin conditions that did not abate with medical treatment. 

When I decided I wanted this done I new the overhang would be close - it hung just to the pubis and most of that was only because I had a super fatty pubis so I knew it would be a gamble.

However I began documenting my rashes by getting my medical records from my PCP, perscription records from my pharmacy, my husband took pics of the rashes i got and I also asked my pcp to write a letter.  I also sent a letter explaing my day to day life with the rashes and wound care and how much it costs me each month.

I was very lucky to be approved from both panniculectomy and abdominoplasty.  You canould try and find the criteria online by googling CPT Code 15847 (abdominoplasty) and 15830 ( panniculectomy) and your insurance company and seeing if you could find the criteria.

I cannot say if the insurance will decline you based on 64 pounds   I have seen some reports where people were declined because they had not lost 100.  I had lost 100 so i don't know if that was a factor for me or not.

Thank you for your information. I spoke briefly to insurance company they said that it had to be a medical necessarity and I needed a letter from the surgeon, not my medical doctor, which someone else told me I needed the letter from my medical doctor talking about my rashes, etc as you did. I figured I would at least get the ball rolling and find out what they decline and what they might need. I go see a surgeon on December 5th for additional letter and pictures and go from there. I am assuming I should lose the 100 total so, I am starting back on that venture now. So, I can lose while I am waiting to get approved.
I will check out those CPT codes. Thank you so much.