Question:
I am almost 1 yr out and about 35 lbs away from goal. I will wait until I am

at goal to even see a plastic surgeon. What does insurance look for in approving surgery on the tummy, inner thighs and "bat wings"? I have BCBS of Alabama with BellSouth. I know they may not pay for the arms, but I am going to give it a try.    — Wendy S. (posted on April 19, 2004)

April 19, 2004
Good luck on them paying for the thighs also. Unless they are so huge they are impeding walking I doubt they will ever pay for them. Bat wings, 99% of the time are cosmetic so it's real hard to build a case for them also. I'm not even going to waste my time on those two and I have pretty significant skin on both, but no rashes/infections or impedment in daily life, just how they fit in clothes and look naked. <p>As far as the TT goes it will depend on your particular situation. While I have never had any rashes, sores or infections under the skin I had a long history or degenerative disc disease in my low back and tons of low back pain. I received all kinds of treatment for it from chiro, to PT to epidurals to living on anti-inflammatories. I got letters from my PS, WL surgeon, neurosurgeon and orthopedic surgeon. The one that carried the most weight, no pun intended, was the orthopedic's letter. His letter proved that it was a mechanical problem that could benefit from the skin pulling me forward etc. They didn't like the neuro's letter as that was to iffy as to how it would help. <p>When we submitted the first time they denied it but indicated they would review it again, when I was down more weight (we submitted about 80 lbs from goal), with new pictures and an ortho eval and recommendation. We resubmitted at about 50 lbs from goal. I figured by the time I got an approval and got scheduled etc. I'd be close to goal. I came out of surgery 2 lbs under goal. The ortho did a great job and indicated there was absolutely no question that removing the skin would help relieve stress in my low back etc. I had approval two days after they had his letter and new pictures that showed the real me. The picture the PS had submitted sucked to say the least, so I had my friend take some of me and hand delivered them to the local office of BCBS along with a letter indicating my history of back problems. I told them that I realized this would not cure my back but it was a logical way to manage the condition, just as all the other treatments I have used and will continue to use. Heck a darn epidural was almost $1600 last time, so the cost of an abdominoplasty wasn't so out of line and this should be permanent, not like an epidural. I can honestly say back issues have been pretty non-existent since I had my lower body lift 8 weeks ago. They had actually improved quite a bit prior to PS but are even better now. I do not find myself taking anything for back pain any more. Knee pain at times but not back. <p>Look for something specific to build your case on and then get supporting letters from medical professionals. Don't just rely on the PS to fight for you. I got my approval because I took charge and got BCBS what they wanted. If I had left it to the PS I doubt I would have gotten approval. They talk a good game but won't stick their heads out there and fight too much. That's my experience with two PS's. The one I got approval with and the one I eventually had the surgery with. The 2nd one submitted for approval of the lateral thigh lift, but he didn't include any details I asked him to which might of helped get it approved and I ran out of time after my surgery to appeal it. So I had to pay for that portion.
   — zoedogcbr

April 19, 2004
Hi Wendy, Don't set yourself up for failure or frustration regarding thighs and batwings. I have known BCBS of Alabama to pay for two people's thighs and one woman's batwings. In all cases there were VERY serious and significant issues with mobility, hygiene and overall health that impacted their decision to pay. We have done over 1500 patients in our program and significantly more than that have come through our support group meeting and still we've seen BCBS of Alabama cover thighs for only 2 people and arms for 1. NOW - it's not uncommon to be denied for panniculectomy on 1st submission. I think they just want us to really work for it. They generally want to see photos of the apron covering a significant portion of the pubis. Additionally they want to see evidence of skin conditions or ortho conditions resulting from the apron. Best wishes to you!
   — ronascott

April 19, 2004
One thing to keep in mind is that since we are covered by BellSouth, who administers the program, our guidelines are a little different from "standard" BC-BS of Alabama. From what I understand, any reconstruction is very difficult regardless of the insurance company. I didn't have a problem with approval for RNY, but I'm not very hopeful on plastics. Let me know what you experience - I'll do the same. Good luck!
   — Debra R.