OMG!! I was approved by insurance!!

I had a gastric bypass in June 2009. I lost 120 pounds. I have Personal Choice Blue Cross/Blue Shield. They just approved me for a panni and breast reduction. I asked for the full tummy tuck but they only approved a panni. I will upgrade to the full tummy tuck. The surgeon's office was surprised I got approved since insurance companies have been so tough lately.

For those of you that are interested, here is the criteria my insurance company asked for me to meet:

6 months of documented rashes     pictures of rashes     loss of 100 pounds or more     stable weight    

panni hanging to level of pubis 

I'm not sure what to do about the breast reduction....I don't really want to make my breasts smaller. However, the skin is so stretched out and they are hanging down so low and I get rashes under them. I'm not sure what the insurance company will require the PS to take off. I'm afraid I won't like them.....but I really need the lift part of the surgery. Has anyone else dealt with this problem?

I'm really excited but scared too. I'm so grateful that insurance is going to cover this!!! I meet with the surgeon on Wednesday. I guess I'll find out more then.

Best regards,

Kathy

Fantastic news!
My boobs looked like hanging long sausages when not tucked into a bra. Now they are small mounds which I much prefer. I only wish the side boob blubber could have also been removed. You can ask for autologenous (sp)where your own fat is redistributed into your boobs to give it fullness.
I want anything extra to be removed.
You are gonna be so happy with flat tummy and no rash and smaller boobs without chafing on your ribcage.
Mikimi in Israel

Thanks Mikimi,

I love the way you described your boobs....lol.....that is how mine look too. The autologenus is a good idea. I hadn't thought of that......I will ask my surgeon about it when I see him on Wed. I hope you are doing well.

Thanks again,

Kathy

For the six months doc. rashes did u go to your primary care, surgeon, or have pictures that had time stamp?  How did you find out the requirements?   I am only 6 months out from my Sleeve and know that i am going to be needing a TT or LBL at some point and would be most interested in trying for insurance approval for as much as possible :)

 

Thank you for your help!

Hi Ashley,

For the six months of rashes I went to my primary care doc. Each month she documented in her office notes the rashes I had.......under breasts and panni. She also kept track of the medications.....creams and lotions etc. that were prescribed to try to combat the rashes. After the creams etc. didn't work and the rashes kept coming back she referred me to a plastic surgeon. He took pictures of my rashes and my panni hanging to the pubis. I also had my husband take a pic of the rashes every time I had one and I gave those pics to the plastic surgeon to give to the insurance company with his request for approval of surgery. My plastic surgeon gave me the list of requirements because he already knew them for my insurance company but you can call them up and ask them to send you their list of requirements for, "reconstructive surgery" after massive weight loss as a medical necessity. That part is very important. You are asking for reconstructive surgery not plastic surgery which is medically necessary not cosmetic. Let me know if you have any more questions. I hope this helped!!

Good luck,

Kathy

Hi Kathy,

Congratulations!   I was recently approved for an abdominoplasty by Anthem by Blue Cross Blue Shield, probably would have been approved for the breast reduction too but my plastic surgeon thought if we sent them too much at once we would be rejected.  Yes, my requrements were the same as yours.  I will probably submit for the breast reduction surgery later this year.

 

I think my surgeon said something about maybe doing the breast reduction then me paying extra for an implant on top of the reduction to make it more natural looking, otherwise I would be a small B.  You might want to ask your surgeon if that is a possibility.   He said that would make me a larger B or C cup and very natural looking. 

Good luck and congratulations again!

 

Robin

Thanks Robin! That is a good idea about the implants. I am seeing my surgeon this evening so I will ask him about that. I'm glad you wrote. Good luck with your surgery!!!!

 

Kathy