Question:
I've heard some are getting insurance approval for a belt lipectomy??!!
PLEASE, if there's anyone here who has gotten approval for this, how the heck did you do it? This what my plastic surgeon has recommended, but I figured I'd be lucky to get approved for an abdominoplasty, much less a belt lipectomy. Yet lately, I've seen posts from people who have. How? And if I were to submit a claim for the lower body lift and it was rejected, would I then have to submit another claim for an abdominoplasty, or would the insurance company come back with "No, we won't approve the LBL but you may have an abdominoplasty"? In other words, am I better off shooting for the moon on my first try and hoping they'll approve less as a compromise or am I better off to submit for something likelier to be approved? I would think that if they reject the LBL, I could try again for an abdominoplasty, no? Also, I have one more question - for those of you that have had tummy tucks, wasn't the excess skin on your back even odder looking in comparison to your flat front? — sandsonik (posted on March 26, 2004)
March 26, 2004
Sandra,
My plastic surgeon submitted a request for three lipectomies: abdomin,
right and left flank. It took forever but it was approved. All I paid was
my co-payment.
— Pamela B.
March 26, 2004
Sandra, According to my PS there actually is not a procedure code for a
LBL but instead it is actually two procedures - abdominoplasty and lateral
thigh lift. When I saw the PS that ended up doing my surgery I already had
approval for a full extended abdominoplasty and he submitted for the
lateral thigh lift portion. It was denied as cosmetic. I do not think it
would have made much difference if they had been applied for at the same
time. I think I still would have gotten approval for one procedure and not
the other. I did do the LBL and paid for the lateral thigh lift myself.
<It all comes down to what a surgeon calls the work he wants to do.
What I've been seeing lately is that a belt lipectomy doesn't do as much as
I originally thought and in some respects is equal to the full extended
abdominoplasty my surgeon did. This procedure alone would have done the
360 degree cut. Abdominoplasty's vary in how far around they go based on
each person's anatomy. I'd talk with the surgeon and see how he plans to
put his letter together. I would think it would be in your best interest
to ask for approval for both procedures but to mention them separately
(with their appropriate codes) in the letter so your insurance can choose
to approve at least the abdominoplasty if they want.
— zoedogcbr
March 26, 2004
Ditto to previous posters. I had belt lipectomy on Dec. 22 and it was fully
covered. Remember the magic word is RECONSTRUCTIVE, not cosmetic.
— Steve B.
March 27, 2004
Hi Sandra. It's all about "medical necessity." Your PS must
write a letter describing the problem, your symptoms, and hopefully photos
and notes from other doctors that describe these issues. Common problems
are skin rashes, infections, folliculitis (ingrown hairs), yeast
infections, rashes, etc. My practice is to try and get everything done at
once, then see what they approve. The patient and I then work out what
will get rid of their problems and also look as good as possible within
their financial limits. JL
— DrL
March 27, 2004
Hi Sandra. It's all about "medical necessity." Your PS must
write a letter describing the problem, your symptoms, and hopefully photos
and notes from other doctors that describe these issues. Common problems
are skin rashes, infections, folliculitis (ingrown hairs), yeast
infections, rashes, etc. My practice is to try and get everything done at
once, then see what they approve. The patient and I then work out what
will get rid of their problems and also look as good as possible within
their financial limits. JL
— DrL
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