Question:
I HAD THE WLS IN JULY OF 2005. HOW HARD IS IT TO GET YOU INSURANCE TO PAY FOR IT

I WANT A TUMMY TUCK AND WHAT EVERY ELS I WILL NEED. WHAT DO I NEED TO KNOW ABOUT GETTING APPROVED HAVING BLUE CROSS.    — grandma62 (posted on April 22, 2006)

April 22, 2006
I know not to call it a tummy tuck. The medical term is (not sure of spelling)peniculectomy. Most plastic surgerons know the questions to ask and the answers to the questions for insurance to cover. If you find a good plastic surgeron,they know what to do.
   — Goodwitch

April 23, 2006
Most insurance plans don't cover plastic surgery. YOU need to do your homework on this one - find out exactly what your plan will and will not cover and go from there. Plastic surgeons are generally way too busy to really try to get your surgeries approved. My biggest suggestion would be (like the other poster said) don't ask for a tummy tuck - you want either a panniculectomy or an abdominoplasty; what you have depends on the extent of what needs to be done. Educate yourself on this. Next, you need to refer to this as reconstructive surgery - might get you farther than referring to it as plastic surgery, or cosmetic surgery. Good luck; you'll need it!
   — koogy

April 24, 2006
Hi Barb, I'm pre-op, so I haven't needed this info yet, but here is what BCBS policy is. You will have to look a your contract for any exclusions. Coverage: Abdominoplasty (which may include performance of panniculectomy) is considered reconstructive and medically necessary when clinical documentation supports the following criteria: Panniculus hangs to or below the level of the pubis; AND The panniculus causes chronic intertrigo that consistently reoccurs or remains refractory to appropriate medical therapy that includes systemic antibiotics, topical anti-infectives, anti-inflammatory medication and appropriate skin hygiene. Repair of diastasis recti (separation of the rectus muscles of the abdominal wall) is considered not medically necessary, except in the presence of a true midline hernia (ventral or umbilical). Codes: CPT Codes: HCPCS Codes: 15831 None ICD-9 Diagnosis Codes: ICD-9 Procedure Codes: 278.00, 278.01, 278.1, 701.9, 729.39, V50.1, V51 86.83 Description: Abdominoplasty, or more commonly referred to as a tummy tuck, is a procedure to remove excess skin and fat from the middle and lower abdomen in order to tighten the muscles of the abdominal wall. The definition of a Panniculus is a fatty layer of subcutaneous tissue. The development of a panniculus can occur from a large amount of weight loss. A surgical procedure known as a panniculectomy can be done to remove the excess fatty layer of tissue. Intertrigo is an irritant dermatitis in the folds or opposed surfaces of the skin. It is caused by skin friction, sweat retention, moisture, warmth, and concomitant overgrowth of resident microorganisms. It most often occurs in morbidly obese adults. A complete abdominoplasty will usually take between two to five hours, depending on the extent of work required. The surgery involves making a long incision from one hipbone to the other above the pubic area. A second incision is made to free the navel from surrounding tissue. Next, the skin is separated from the abdominal wall to reveal the vertical muscles that will be tightened. This provides a firmer abdominal wall and helps to narrow the waistline. The skin flap is stretched down and the extra skin is removed. A new hole is usually cut for the navel and then stitched into place. Finally, the incisions are stitched, dressings are applied and any excess fluids are drained from the surgical site. A partial abdominoplasty may take as little as an hour or two. A much shorter incision is made and the removal of the navel is usually not required. The skin is then separated only between the incision line and the navel. This skin flap is stretched down while any excess skin is removed. Finally, the flap is then stitched back into place.
   — jlflbf