Panniculectomy VS Abdominoplasty

Quick question:  It seems like many of you were able to get insurance to pay for a full abdominoplasty (tummy tuck with muscle tightening) rather than just a panniculectomy (skin folds below belly button only).  Did you have to send in extra documentation of back pain, etc, or something related to the lax muscle issues to get the tummy tuck approved?  Was the abdominoplasty as well as the panniculectomy requested, per CPT code?  My Dr doesn't want to put in for the abdominoplasty because he says it is never approved and can cause the panniculectomy to be denied as well.

Just trying to gather info and experience.
Thanks

My surgeon initially requested coverage for me to have a circumferential body lift which of course, was denied. The insurance company initially said that they would approve me for a panniculectomy but when I pushed them to clarify the criteria they used to distinguish between the two procedures, they suddenly upgraded me. Go figure. So, now I'm covered for an abdominalplasty (which I am very, very grateful for) and I am paying the difference for the rest of my procedures. I still have no idea how Blue Cross determines who gets a panniculectomy and who gets an abdominalplasty (aside from giving the latter to the "squeaky wheels" who challenge them).

 When I called blue cross for the specific information on determining the criteria I was told if the skin hangs to the mid part of the groin or lower it is approved for the panniculectomy and "on very rare cases" an abdominalplasty can be approved with proper documentation. 
In my case....mine does not hang that low, so I tossed insurance right out the window....
It's been 3.5 years since my gastric bypass and it's not been until the past 2 or 3 months that the skin has become itchy/moist and irritated on a daily basis. I do plan to go to my pcp with this new issue to begin documentation of it....in hopessssss I can be approved with insurance one day. sigh.

Interesting... The criteria that Blue Cross provided to me said "evidence of recurring rashes and/or non-healing ulcers". There was nothing about measuring the overhang.

Thanks for the responses. I think I will call my insurance company and see if I can get anything out of them. I called before and was told it was just determined on a case by case basis for panniculectomy, but, I have a person in the know's number now, so maybe I will get better info. I have trouble with my back stiffening up every night and my kidneys hurting in the mornings if I sleep on my back which I know is caused by the weight of the panni and a few other issues with my innards leaning the wrong way due to lax muscles to hold them in the right place that I am hoping will sway them in that direction. Unfortunately, none of that is bad enough for medical intervention so I will probably just have to go with the panni and hope getting the weight off allows me to strengthen the muscles enough on my own to fix the other problems.
Thanks

I would definitely push back on their "case by case" response. They absolutely MUST have clear, consistent criteria. Insurance companies can't make arbitrary decisions about approvals (though it seems as if they usually do).

I was approved for a panniculectomy.  According to my surgeon though - they do the same procedure for a panniculectomy as they do for a abdominoplasty.   They never just take the skin from below the belly button, but do the full pulling up of the skin and redoing the belly button.

I did not get any muscle tightening.  My doctor felt my muscles and said she did not feel any separation at all, so it wasn't necessary.

I feel lucky that my hospital does it that way, as BCBS only approved the panniculecomy.  I am sure it was coded as such when they submitted it.

You should specifically ask your surgeon what the procedure is for each surgery, just in case there is some confusion.