Question:
ANYONE HAVE BC/BS PPO IN ALABAMA AND GET APPROVAL FOR A TUMMY TUCK AND/OR BREAST LIFT

If anyone has gotten approval from BC/BS PPO in Alabama for a tummy tuck and/or breast lift, can you tell me how you did it......    — tia S. (posted on August 11, 2003)

August 11, 2003
Hi! Sorry to answer a question with a question but......have you applied for coverage and been turned down? The reason I ask is that it is very common to be denied on the first submission. Also, just like they can do with weight loss surgery, some employers can put PS exclusions in their policies. If your policy has an exclusion they are VERY hard to overcome. I've had some patients who really gave it their all only to end up still being denied. You can email me privately if you'd like and tell me who you work for and I can let you know if we've had any experience with that particular employer and whether or not we've had any success. By the way - you had surgery in my hometown!! It's a small world isn't it? Best wishes!
   — ronascott

August 11, 2003
Well, I don't have PPO but I have BC/BS of Florida HMO and I just had my full TT with muscle repair on July 8th and my insurance company cover 100%. The key is to prove medically necessary. I had documentation of lower back pain and rash along the pubic line. Keep in mind that I was denied at first buy I stuck to my guns and demanded it was not cosmetic surgery that it was reconstructive surgery. After first appeal I was approved! If you would like to see copies of my insurance letters just email me at [email protected] and I will email them to you.
   — Jeanette D.

August 11, 2003
Yes. I have BCBS of AL, PPO. I had my TT on 12/31/02. I had taken pics of my abdomen with rashes and used them for my doc to help plead my case.
   — Dianne B.