Question:
Talked to a PS today and she said BCBS/PPO will not pay?

The PS told me that in 16 years she has never had BCBS pay for reconstructive surgery just because of excess skin and she also said that I can't do anything for my skin, but deal with it or pay out of pocket to make myself feel better. I have been told by other WLS members that there insurance has paid. Now im confused! Did I just talk to the PS who does'nt care, should I keep looking? I am so lost on all this and getting pretty upset over my skin, that I guess will never be normal again! Thanks for the help!    — Sandy M. (posted on May 14, 2003)

May 14, 2003
I dont know which BCBS/PPO you have; But I had BCBS/PPO in NC and they certainly DID pay for a admonioplasty (with out the muscles) I had to go to level two appeal; but it was APPROVED! I have noticed that some PS dont like to deal with insurance. My first one didnt; the second did. If your in an support group; ask around ... ususally the PS that does get it approved word of mouth gets around. Good luck!
   — star .

May 14, 2003
If only I were so lucky to still have BCBS. January 1st of this year my hubby's company switched to the evil United Healthcare PPO. My plastic surgeon's office is great about submitting to insurance, any insurance. But they said BCBS is by far the best to deal with and UHC is probably by far one of the worst! Ugh! Find another PS!!! NOW!!! - Anna
   — Anna L.

May 14, 2003
Hi Sandy! I did you, by chance happen to have your PS consult with a female surgeon in Georgia? Just curious because I'm thinking of going to a FANTASTIC surgeon that's located here in Georgia. If you put her name in under the Plastic Surgeon area, you will find that she has done quite a few surgeries. More, I think in the state of Georgia (so far as our AMOS brothers and sisters have indicated). I've got some time yet that I will have to wait for these "jiggly thighs", my tummy, the "batwings" and breasts will definitely need some work. I have BCBS of Georgia-PPO for Federal Employees-Standard option. I wouldn't fret too much over whether they would pay or not. BCBS of Georgia REALLY surprised me! Actually, with the sagging skin now and the problems it's causing, I wouldn't be surprised IF they did pay for what I NEED~~and NOT entirely cosmetic. 'Ya know what? I don't have anything bad to say about the way BCBS, at least of Georgia, handled my business. I guess it just depends on the credibility of the PS/WLS one has decided to go with. For the most part, BCBS requires documentation and in the case of plastic surgery, would more than likely want some pictures or something...I don't know, but I'm going to have faith and keep trusting God, because..."I am fearfully and wonderfully made"...Psalms 139:14:o) Hadiyah, a.k.a~~
   — yourdivaness