BCBS Federal Insurance

hello everyone,I have insurance through my federal job. I was wondering if anyone knew how to get them to cover plastic surgery such as an tummy tuck,thigh lift,arms, basically anything that help remove excess skin. What Im really trying to see is what do I need to tell my pcp to write up to get the insurance company to approve this for me. If anyone had this approve with this type of insurance please inbox me  or repsond to this to let me know what my doctor needs to say in order to have this covered.

Okay, I do not know in terns of your insurance buy they all want documentation of rashes sores or bodily aches (back and shoulders,knees) depending on part of the body you need/want done. Photographs from PCP, skin doc or orthopedist might also help.
You are not looking for Cosmetic surgery but you need Reconstructive surgery for your body to return to a place of normalcy. (Even if you have been fat all your life-your claim is for now to gave a "normal" body).
Ask (or research) for a copy of your insurance claims format if what they do cover. It all depends on the wording when you apply but a formerly fat person seems to be entitled to more than we realize! Fight and fo not give up. Yoi are surely worth it!
Mikimi in Israel

I also have the BCBS Federal insurance. I am still in the process of finding the right plastic surgeon, so I have not submitted to the insurance yet. I have called our insurance provider three different times to ask about coverage, and so far it seems that none of these surgeries are specifically excluded. I even gave them the CPT codes for both the panniculectomy and abdominoplasty just to make sure, and I was told they do not exclude abdominoplasty, it just has to be considered medically necessary. I asked about what qualifies these surgeries as medically necessary (like back pain, rashes, hernia, how much weight you have lost ext), and they did not have any more information on that. Apparently, all you can do is have your plastic surgeon submit for pre-approval and it goes to medical review. 

However, one thing to keep in mind is that just because insurance may pay for several of these reconstructive surgeries, a plastic surgeon may not take insurance payment even if they are in network. I had a consult on Friday, and the surgeon specifically told me she will not accept insurance for arm lifts, thigh lifts, lower body lifts ext, the only procedure she would accept insurance payment for is the abdominoplasty. This is definitely something you should discuss with your prospective surgeons during your consultations.

Do you have standard or basic? Please keep me updated any anything you find out, and good luck!

-Angela

I have the standard. im just getting in the procrss. i got more weight lose. i want a lbl,thigh lift. i may have to pay for my butt lift

Hi ladies, did either of you have any success with BCBS federal?  I have the 'basic' plan and would like to submit something for PS, but I'm not sure how to go about it!  Any information would be helpful.
Thanks!
Jen

 I have BCBS FEP standard.  I have had 2 rounds of plastics.  My first round was the most extensive. I had a very, very large pannus.  I had LBL, tummy tuck with anchor cut and BA.  The only thing they paid was the Panni.  My surgeon billed them 5,000, they paid him 1850 or so.  The do not pay for anesthesia if you have other non-covered procedures.  I didn't really have rashes or anything, but my pannus was so large, it was considered a grade 4 out of 5.  

I am very pleased with my outcome and will have another abdominal tweek soon. With so much work, sometimes a revision is necessary.  It has been worth every penny.

Jinjer

When you say that they only paid 1850 of the 5000....does that mean you had to pay the difference in order to have just the Panni done?  Congrats on the successful surgery!!!  I am hoping to have at minimum a tummy tuck (praying I can get the panni covered and then pay the extra for a TT).  Ultimately I would like to have a LBL, but I'm not sure that is ever going to happen.....

Can you tell me what you mean by a tummy tuck with an anchor cut?

Thanks
Jen

 I honestly don't remember how much of the remainder of the 5000 I paid or if I didn't.  I paid a big bill so I can't really remember.  The anchor cut is where they make a vertical incision above the waist to reduce the "muffin top."  I would not have gotten a good result if they hadn't done that. 

Jinjer