Question:
Has anyone had Anthem BC/BS Community Choice pay for abdominplasty?

I have went to my pcp and he has referred me to see a plastic surgeon for a abdominplasty... pcp said that sometimes just his referral and the plastic surgeon's referral is enough to get ins to pay... I hav Anthem BC/BS Community Choice... if there is anyone out there that has had this ins and has had experience with getting approval for a abdominplasty please let me know your experiences... the approval process... what hoops you had to jump thru to get it done... how much of the surg did they pay... anything any info is great. You can e mail me privately if you'd like... Thanks a bunch    — Bonnie S. (posted on July 13, 2002)

July 14, 2002
What an insurance company will pay depends on the type of plan you have. If approved, they will pay it like any other normal surgery. As far as getting it approved, submit a letter with all the problems you have with your excess skin and submit pictures. Pictures are the key. Then they can see how much excess skin you truly have. Stand to the side and take your skin and pull it out as far as you can and have a picture taken. A picture is worth a thousand words. A letter from your PCP with all the docmented problems you've had due to your excess skin (rashes, odor, etc.) would be very helpful to you. A letter from your plastic surgeon is also helpful, but I've found that the plastic surgeon's letters aren't very good. They know they will be paid no matter what - whether from the insurance company or from you. They make a LOT more money (if your on a PPO or HMO plan) if the insurance DOESN'T pay because then your forced to foot the ENTIRE bill yourself. If the insurance pays, they are forced to take a reduced fee. For example, I have a PPO plan. The first plastic surgeon I went to see was a non-network doctor. He told me he wouldn't write a medical necessity letter for me if all he was going to get was 2 or 3 cents on the dollar for his surgical work. Had he been an in network doctor, that's how much he would have received from the insurance company. I assured him since he was non-network he gets the entire amount of what he charges, even after the insurance company pays, I would pick up the balance. He then agreed to do the letter. However, once the insurance company approved me, I decided NOT to use him as it would have cost me about $2500 out of my own pocket. Also, I found an in network plastic surgeon who wanted to make less incisions on me therefore leaving me with fewer scars. By switching to a PPO doctor, my insurance is paying 100% of the plastic surgeon's bill. However, the PPO allowed amount is only about $1400. His normal fee is about $4000. He must write off the difference between the $4000 and the $1400. This is why some plastic surgeon's letters aren't the greatest when submitted to the insurance company. For the other surgical procedures that aren't going to be covered by the insurance company, this is where the plastic surgeon will make back some of the money that he lost due to a procedure being covered by insurance. My in network plastic surgeon is also doing my arms in 2 stages and is charging me $3600. It looks like the going rate for this surgery in my area is about $2600 to $2800. However, I'm willing to be pay the extra money because I figured I still came out ahead from the abdominoplasty work and I like the way he's going to do the surgery versus the other doctor. I know it's long winded but I hope it helps explain things better.
   — Patty H.