BCBS plastic surgery coverage

Does anyone have any tips on getting Blue Cross Blue Shield to cover a lower body lift after RNY? Thanks!!

Rhiannon

Read your plan document provided by your employer about your insurance coverage to see if it had the requirements for getting reconstructive surgery covered. Also call since every plan is different. Also document everything, rashes, back problems basically anything and everything you can think that is being affected by the hanging skin. They may not cover a full Lower body lift but you may get a panni removal out of it.

You have to build a case record with your PCP for ALL the area's you want reconstructed. It is VITAL that your treatment chart spells out all the areas that are ulcerated/irritated AND unimproved with medical treatment. This builds a case for medical necessity at a functional level VS. an elective procedure. I went to PCP 4-5 times, make sure you get all prescriptions filled as BCBS has that info. I noticed someone posted knowledge of using an emery board to hilight area's affected. I was denied Panni. coverage on not hanging low enough "pubic area". I was approved on first appeal when I noted how arbitrary "pubic area" is given the anatomical differences are from person to person. Most notably are the anatomical variances in upper and lower torso's. I emphasized what is real. A condition that is infected, very painful when exercising and showering, systemic infections to the whole body, decreased immune function from fighting these infections, odorous, bleeding that sticks to clothes.visibly, embarrasment from items listed, sleep deprivation from pain, decreased and affected work profficientcy from conditions listed and an overall reduced quality of life.I only went after and received Panni coverage. I had a LBL and mini med. thigh lift. I plan on asking for additional benefits after the fact and believe I will be successful.

I have BCBS and I got an extended tummy tuck covered.  I had my family doctor send a letter stating that I was being treated for yeast infections underneath the hanging skin and all the presecription creams that were prescribed were not working.  Plastic surgeon submitted photos and I was approved right away.  Good Luck....even though I was approved for the extended tummy tuck I wish I would have gotten the full LBL done and paid the difference. 

I have BCBS as well and i checked my plan to see that excess skin and fat were covered provided you could prove medica necessity.

I got copies of my medical records, perscription records, and a letter from my PCP.  I had 2 years worth of documentation.  I had my husband take pics of the rashes when they showed up. I also wrote a letter deacribing that the medicine that was perscribed was not only ineffective but made my skin peel off in sheets which cause painful lesions.  The letter also described the impact on my daiy life and the monthly cost associate with wound care.

I was approved from a Panni and TT on the first go.