Tummy tuck covered by Blue Cross

I am looking for some advice on plastic surgery. I was approved for a tummy tuck with 1 surgeon, but went for a second opinion and now I like the 2nd surgeon better. In order for her to submit her pre-approval to my insurance I would have to cancel my first pre-approval. I am a little nervous because I am afraid that they may deny it with the second surgeon then I won't be able to have the surgery. Has anyone been in a similar situation as this and can give me any advice?

I had the same situation with BCBS federal.  I gave a copy of my pre-approval letter to my new surgeon, and her office manager just called my insurance company and switched doctors. All it took was one phone call, I didn't have to re-submit for approval! Let me know if you need any more info!

-Angela

Will you both please kindly tell me why the insurance co approved the TT? What was the medical criteria? I have heard it is very difficult to get the insurance to cover this. Thanks!!!

I have blue cross/blue shield. I'm not sure how the surgeon got it covered, but he did. He put it through as abdominoplasty with lipo I think. He took pics and documented problems I've had.

Who was your surgeon if you don't mind me asking?

Who was your surgeon if you don't mind me asking?

It really dependes on your insurance company.  First, you have to find out if it is a covered benefit.  Typically insurance companies only cover the panniculectomy (removal of the skin only), but a few will cover the abdominoplasty (removal of skin and muscle repair).  Then there is a criteria for medical necessity, which will again vary by insurance company. Your doctor will have to submit (usually before the procedure) documentation that you meet the criteria for medical necessity.  This usually includes being so many months out from surgery, having lost a certain amount of weight (usually >100 pounds), skin that hangs to a certain level, rashes, or back pain.

BCBS Federal said that an abdominoplasty was a covered benefit for me, but it is so rarely covered I couldn’t find a plastic surgeon that would submit for preapproval for anything but the panniculectomy.  Instead my surgeon took the payment for the pannic and did the extra work for the tummy tuck for free. I was 2 yrs out from surgery, had lost 160 pounds, had a significant amount of extra skin, and documented chronic back pain, which was enough for my insurance company to cover it.  Good Luck!

Thanks

I have a question, I have Empire blue cross/blue. I just received my approval letter from the insurance company for both an abdominoplasty &panniculectomy.  The surgeon is now playing games. She is a in network with bcbs, but now she says i will have to take out a loan for $6500 for body shaping.  I explained I only wanted what the insurance was covering and she said she wont do the surgery without the body shaping.  I reported her to bcbs and they are doing an investigation.  Now I'm looking for another surgeon who will do what the insurance company will pay.  Can anyone recommend a surgeon who accepts bcbs and will do abdominoplasty & panniculectomy in the NY, Long Island area.

Many times what the insurance covers is subpar.  The work is not attractive at all.  They literally just remove the hanging skin and nothing more.  I can understand her point to an extent that as you go out and show people your results, and they ask who did your surgery, they may be horrified and blame her for her appearance.  I have seen the result of a panniculectomy that was fully covered by the insurance it was absolutely not good.