? about insurance coverage for BR after weight loss

Hi all!!

I am having a TT on 3/23 with insurance covering the paniculectomy (sp) & I will be paying the difference of $5000. to get the full tt bx I have so much skin that hangs over my belly button causing rashes & gross drainage. :(  I was getting a second opinion & the 2nd plastics said I should really consider having a breast reduction also.

He said my frame is very small & my breast size is already disproportioned from my current body size. He said I currently have 8-10lbs of extra skin from my pannis & stomach. I am 5'5". 145lbs.  I currently wear a size large top, but a size 4 or 6 bottom. My breasts are a 32G. I have constant neck pain which I didn't have before surgery. I also have constant rashes & bleeding underneath. My size also inhibits my abilty to do some activities. I have to wear a bra all the time, bx the skin hangs & really hurts after a while.

My question is what information does the letter or documentation need to have for the insurance? MY doctor wrote me a letter to give to plastics, along with a visit history & treatments for the neck pain & rashes. My insurance is BCBS PPO. They have approved my pannis is just 3 days after the paperwork was submitted & it was about the same time frame when I had my sleeve done 9/13.  I am just looking to have the correct paperwork with me.  Thanks for any help anyone has!!

Renee

I haven't had the procedure done myself but I would think as long as you have a letter from the doc as to what you've already done and you are still having problems your insurance should cover it with no problem. It is usually easier to get a breast reduction than a panni removal from others I know. Good luck!

I think you have to have documented that it causes back pain ? Your plastic surgeon should be able to give you the requirements you need.

Every insurance company and plan is difference. I'd suggest calling the customer service number and asking what information needs to be included in your documentation.

Be sure you are voicing your concern about your pain to your dr every chance you get. A lot of insurance companies have benefits for BR but they must review documentation that charts your pains etc...

Good luck to you!

Check the BCBS website for your state of insurance. I am not sure what state you have, but all of them post their medical policies online that tell you the requirements for certain procedures.

Here is the reduction mammaplasty medical policy for BCBSTX.

If you have trouble finding the policy for your state, let me know, I can help you find it.

Thanks for the help!! Pulled up our policy & looks like I should be fine. :)