Did Personal Choice BC/BS Cover your T/T & B/L? Need Advice and Help Please!

Spedteacher59
on 4/20/12 8:44 am - Levittown, PA
Just had my consulatation for a T/T and breast lift. I have a horrible rash right now under my pani and breasts........so bad there has actually been blood on my underwear several times. I went to my primary 2 weeks ago and she suggested reconstructive surgery and sent me to the Plastics doc. Well he said Personal Choice requires 6 months of rashes etc for them to cover a panni. He said, they probably won't cover the full tummy tuck or breast lift. I would have to upgrade from the panni to the T/T and probably pay for the breast lift myself.

My primary doc wrote down.....chronic rashes and irritations in her notes and said she would write me a letter of medical necessity. Should I wait out the 6 months time period with rash documentation or try to put in it for it now to the insurance co. and see if it will pass? This condition is soooo painful I don't know if I can stand it for 6 months. I also haave good pics of the rashes. By the way it's not just a rash.....I have actual bleeding holes in my skin under my breasts and panni. So far the regular cream and then steriod cream has not helped at all.

Have any of you been covered without 6 months of skin disruptions? I need to know what I should do???? Any advice would be very helpful:)

Thanks so much,
Kathy
(deactivated member)
on 4/20/12 10:28 am
I have BCBS and I had a note from my family doctor stating I was being treated for rash/yeast infections and nothing was helping.  Your PS should be able to send pics and notes of the rashes and take it from there.  If they deny you till you have had rashes for 6 months then at least you will know that.  I know when I went my PS recommended an ETT with muscle repair and it was covered 100%..got approved right away.  Good Luck!
Most Active
×