Plastics anyone

Hello All,
It has been some time since I have been on this forum, but this was the best place for me to come and ask about this issue, since I am a lightweight, and was hoping that I could get some input from those who have gone thru this.  The other thing is, if you go for a consult, and it requires paperwork to the insurance co., they charge for the consult, if it will be for selfpay, they told me to tell them it is for cosmetic and they would be no consult fee.  I am not sure if I can push the envelope for an insurance pay, but won't know unless I try.  My insurance is Anthem BC/Bs.
Has anyone tried for plastics with your insurance co. and been successful?  I called my insurance co to ask if they covered plastics after a large weight loss, the answer I got was yes.  They would need copies of my medical records, and if I had gastric bypass they would need to document the amount of the loss.  I also asked if I needed to document any issues I had, and she said it wouldn't hurt. (?)  She kind of acted like it was an easy thing and happened all the time.  The doctor would need to recommend it, I asked which Dr., the plastics or pcp.  She said more than likely my PCP.  I am lucky as my issues are few, just belly button trouble, and backside problems.  I would really be happy if they would pay for some of it, but I don't want to open a can of worms.  Any input would be helpful. 
Thanks, Ena

Wow - when I called my insurance company (Fed BC/BS) they said "NO" to covered plastics - but you have to word it correctly as "reconstructive surgery"...

But - yes, I did get a panniculectomy covered by my insurance.  I paid out of pocket to have the full tummy tuck (vertical incision with muscle tightening).

My Dr told me the same thing about the office visit.  My insurance paid for the office visit, but make sure that its a participating Dr (not sure what your rules are regarding that). 

Also - your Dr's office (PS not PCP) will be familiar with the insurance and what they typically do/don't pay for and will know how to submit it.

Good luck!  Its an overwhelming process but do your homework and ask lots of questions.  If you have to start with your PCP, be sure to ask him/her who they may recommend and be sure you find someone who specializes in doing PS on people who have lost a large amount of weight.  Also, be sure to get several quotes/opinions, and they will differ.

I kind of felt that the person I spoke with didn't really know what was involved,(just knowing from what I have read and heard from others) but rather just responded from what was general knowledge and what they felt.  I did call twice.  Thanks for the info. though.  The surgeons office did give me a card for a plastics guy who my Dr recommends, so I will check, but think he must get some work from my Dr, and more than likely does a lot of WLS patients.  However I will continue to check further.
Thanks

I think the people on the other side of the phone at the insurance companies just read out of the benefit guide - I've had that happen several times.  When they're done, I said "yea, I read that too - but.... this is MY situation"  of course they can't help me but say the Dr's office should know - REALLY????  Why can't THEY tell me?

Good luck!  If they said yes on the phone then that definitely is encouraging.  Mine said no, but then they did....

Although I live in Israel, the 'protocol" is similar most everywhere in trying to get approval for financial coverage.
Ask your PCP/GP to write up your weight-loss and if you have rashes/fungus/smell in your stomach folds of the belly above your pubic hair (bikini line).
Good luck on this added journey and may you have great success!
Mikimi in Israel

Thanks Mikimi

BCBS paid for all of mine, with the exception of the vertical anchor cut (but my doctors threw that in).

I did have a referral in network from my PCP to the reconstructive surgeons, as well as a letter of recommendation/need from the breast specialist at my gyny's office and documentation of rashes/scarring/belly button infection/skin sticking/general nastiness.

It still took 5 weeks for the insurance company to authorize it. And yes, my reconstructive surgeon's scheduler initially refused to submit the request to insurance. I had to nag, beg, and collect the referral/necessity letters myself because, in her words "insurance never covers this." Hah!

I do know that the coordinator at my gyny's office (who actually wrote the letter of necessity the specialist signed off on) told me that BCBS HMO is actually one of the easier insurances to get things covered, but that's in Illinois so it may be different where you are.

I wish my insurance would cover a breast lift but they said they will only do it if it medically necessary.  Somehow I don't think wanting perky breasts is medically necessary.

Yeah, it's tough.  Even with constant back, shoulder and neck pain, I couldn't get it covered.  I was told that there was no way a breast lift would ever be covered, but a reduction MIGHT be (if I were willing to fight), but I don't have enough tissue in the end for it to qualify as a reduction.  I'm frowny now

Thanks for all the input.  I have to say that I am thankful that they paid for the surgery in the first place, and because of work, and then a move out of state, I have had to change my insurance twice since my WLS.  I think that I will try to make it thru the summer and get some documentation, and go back to my pcp in Sept. and try to start the process, the worst they can say is no. ( and yes although I no longer have any junk in the trunk, but do have the bags I can pack, and am uncomfortable sitting for any length of time, and the fluff back there makes wearing jeans that fit a problem, they won't think there is a need, in that area at least.  But thank you all for the help and suggestions.
Ena