Question:
How do I get BC/BS to pay for my tummy tuck?

I read somewhere that I need to be having rashes under the apron. Let's say I don't, How can I create one for the surgeon to see so he can report it to BC/BS?    — jeannie B. (posted on March 6, 2003)

March 6, 2003
I can't believe you've asked how to create a rash. Have you ever heard of insurance fraud? There are other things that can point to medical necessity besides a rash.
   — Pamela B.

March 6, 2003
I don't have an answer for you, but in response to the previous posters, I think that is an awful attitude to have. Granted some will get rashes and some will not, but who is to say you don't deserve the ps just because you don't have a rash? What about the psychological affects of having a hanging panni? How about the people who can't wear swimsuits or sleevless tops because of their extra skin? Some people can't afford to pay out of pocket. I am not saying they deserve it more, but I say they deserve the ps too! P.S. I didn't write this to anger anyone.
   — nchaudoin

March 6, 2003
There was quite a discussion on the message board just recently about people posting this type of question. Please don't. Have some respect for the hard work that Eric Klein and the volunteer moderators do on this site, and PLEASE keep questions/posts that smack of insurance fraud off of here. You compromise the integrity of this wonderful site by even mentioning such a thing.
   — [Deactivated Member]

March 6, 2003
I would never recommend creating anything that is not a problem already. I am haveing my tummy tuck this coming monday. I have BCBS of Michigan and I went to a participating surgeon in my netowrk. BCBS approved me the first time and I did not have a rash. The doctor took pictures and sent a letter and within 6 weeks I was approved. Hope this helps.
   — Rebecca F.

March 6, 2003
There are other medical reasons for having panni removal. The extra weight can cause back pain and it can also cause difficulty walking if it is large enough. The important thing is to document any medical problems you are having. Most insurance will not cover it unless it is medically necessary. Do NOT fake a rash. As one other poster said, it is insurance fraud and you don't want to go there. I do feel bad for anyone whose insurance won't pay for it, but when people deliberately set out to defraud their insurance companies, we all end up paying for it.
   — garw

March 6, 2003
First of all... it sounds like you havent even submitted your request... THAT would be the first step in getting approved. Don't solely rely what you do on 'what you have heard'. With BCBS - submit - then if necessary appeal. It took me to almost level three.. I had a small rash, basically, and I told the BCBS nurse, I self medicate )with baby powder etc to try and keep it under control. BCBS does pay for this surgery. You might have to 'fight' but give it a try.
   — star .

March 6, 2003
I totally understand how you feel. I have been approved for reconstructive surgery for my breasts, stomach and knees. I have federal bcbs and I honestly do not think I would have been approved without having a rash. I was truned down on my arms and it is under review again (and I had a rash under my arms).
   — jan M.