Plastic surgery pannilectomy

I am 14 months out from surgery. I went to see a plastic surgeon today, I have an umbilical hernia i need to have repaired, and i want to get the skin removed. I know insurance use to pay for it, and i know i was told by my insurance that if i lost the weigh i could have both surgerys at the same time and the insurance would pay for it..I went to this plastic surgeon today who said absolutly not the insurance will not pay for it at all. Insurance hasn't paid for it for several years. I think he is full of it, i think he just doesn't want to deal with insurance issue's.

Has anyone had it and it was covered under your insurance..I have blue cross blue shield Anthem.

Any advise is much appreciated.

Janet

 from what i have heard its usually a struggle and seems like they tend to not cover it more than they do. i would check out the plastic surgery board on here

He is incorrect.  Partially, at least.  Many insurance companies still pay for a panniculectomy IF you meet the criteria of having a certain period (6 months is common and is what my BC/BS policy requires) of documentation from a physician of persistent rashes underneath the skin apron (including evidence of having tried non-prescription and prescription medications to alleviate them) and, often, if the excess skin hangs down a certain amount (usually, for both Aetna and BC/BS, below the pubic bone).  If you do not meet the above criteria for "medical necessity", they will NOT pay for it, even if you are already having a hernia repair (which, of course, they WILL pay for).  My insurance (Aetna at the time, but with the same requirements as my current BC/BS policy) covered my panni removal, but -- because of issues with my surgeons -- it had to be done as a separate surgery (and by 2 different surgeons) from my open incisional hernia repair.

Occasionally someone is able to get the insurance to cover a full tummy tuck (removal of excess skin above the belly button (panniculectomy is only below the belly button and does not include muscle tightening) and tightening of the abdominal muscles) is they are having a hernia repair, but many insurance companies have tightened their requirements for these things in order to keep costs down.

You can call BC/BS and ask them about coverage and requirements for your plan for a panniculectomy.

Lora

I have Anthem Blue Cross and was told that they will cover the Panni. Not sure if it matters or not but the final decision was made by my medical group not Anthem. I will have to see my PCP and get a referal just like I would for any specialist. I haven't actually done it yet so that may change.

 Hello, congratulations on your weight loss.

I can tell you there might be some insurance policies that have that as a plan restriction.  However, your best bet is to find  surgeon willing to do the work.

Have the surgeon submit a pre-authorization request to your insurance company.  It should include photos - (hopefully you have preop) - they dont' have to show your face.  It should give a history of your weight lost and any medical problems the excess skin might be causing including back pain, rash (like the other poster said).  The should indicate how much weight you have lost etc.

I have seen it paid for before so don't give up hope.  

The info just has to get to the medical review department and if medical necessity can be demonstrated they will more than likely cover it.

A well known plastic surgeon speaks at my support groups each year. He says that the panni is still done by most insurance companies, PROVIDING you have doctor's documentation of a history of fungal infections, rashes, photos of areas, or your doctors opinion that the excess skin impedes walking or doing exercising.  Insurance companies will likely pay for the surgery with this documentation and your primary's referreal.  Bear in mind though, the panni only removes the excess abdominal skin--no tightening of abdominal muscles, won't look as pretty as standard plastic surgery and you may or may not wake up with a belly button. This plastic surgeon says he does many tummy tucks each year on panni surgery patients.  They are unhappy with the physical appearance of the panni surgery, and will likely still have loose belly areas, just most of the excess skin has been removed.  This surgeon is working with at least Kaiser insurance to lessen the cost of a TT, since he thinks 2 surgeries for the same result is more difficult on the patient. I know he works with Kaiser, basically reducing his fees by the cost of Kaiser's operating room and anesthesia costs. This lessens the cost of a TT by $2000 or more.  DAVE

Well two years ago i was going to have my hernia fixed and the surgeon said that because of my pannis it would just herniate again. so he sent me to a plastic surgeon who sent all the documentation ( i did have alot of infections) the medical review board was the one *****commended the gastric bypass because it was covered under the policy and then told me if i lost a significant amount of weight i could probably get the approval. That was two years ago, i guess i have to just go thru that same process and see what happens. I think this plastic surgeon is just looking for that cash busniess. But 9500.00 is alot of money.