Question:
Can someone please tell me if they have been approved for a TT with BC/BS Federal?
What are the requirements, my plastic surgeon told me they wont pay for it, but i think they just dont like dealing with insurance companies. — charrise R. (posted on February 12, 2003)
February 12, 2003
I don't have an answer BUT I did read my fed BCBS policy closely. It
doesn't say No, it says No, EXCEPT in the case of ...blah..blah...caused by
a condition from a disease (morbid obesity) or surgery ( RNY). I am 10#
pounds from goal and wanting this clarified also. I want to hear from
anyone who FED BCBS did pay for!
— Connie M.
February 12, 2003
I had RNY on 3/6/02 and have lost about 137 lbs. I went for 2
consultations for plastice surgery. One was in Kansas City and one in
Wichita. The one in Wichita submitted the infor to federal BC/BS in Topeka
and the one in Kansas City submitted it to the Feral BC/BS office inKansas
City. I have a verbal approval from the Kansas City office to have my
stomach, breasts, and knees done. The office in Topeka wrote and wants
more info. I had already decided to go with the Dr. in Kansas City. Right
now I'm waiting for letter of approval and then we will check and see what
my out of pocket expenses will be and schedule a date. I honestly have not
heard of anyone else being approved with this insurance. If you have any
questions email me.
— jan M.
February 12, 2003
i just called bc yesterday & asked this same exact question. the answer
given to me was this...'as long as the procedures r medically necessary
& not cosmetic, yes, they r covered.' i was instructed to stay in
network when looking at plastic surgeons & the hospitals they use, call
bc if i want, to get their evaluation of the surgeon, & when i chose a
surgeon, have him call the provider unit of bc & give them the
diagnosis & procedure code(s). if the procedures r medically necessary,
a pre-certification will be given. u can then call bc & get a
confirmation number that gets assigned to the pre-cert. remember-fed bc
does not pre-approve, they pre-cert, but, i myself have never experienced
any problems with my bills being paid as long as i followed the rules. i
also want to pass on some advice. take pics of ur body showing what u want
corrected eg: hanging apron, sagging breasts, any rashes u might be
suffering as a result of all the excess skin, slumped shoulders that r
pulled down by sagging breasts & causing backaches etc. get them
developed in doubles. give one set to the surgeon u choose to attach to ur
file. if bc wants 'visual' proof all the dr has to do is submit the pics.
good luck!
— sheryl titone
February 12, 2003
I answered before, but just thought I'd add that prior to my plastic
surgery consultations I too checked with the ins to see if they would pay.
I explained my weight loss and problems and they told me to see a plastic
surgeon and submit for a predetermination, but that the chances of approval
were not good. I know of one woman who had very sever rash problems and
she was denied. I personally feel there are 2 critical things needed for
approval. One is when the plastic surgeon submits it for the
predetermination it is essential that they code everything correctly and
write it up the right way (whatever that is). Some just seem to be better
at this then others. The other factor is who at BC/BS is making the
decision. That is out of our hands, but it seems like it does vary as to
who it is. Good luck!!
— jan M.
February 17, 2003
i have bcbc of south carolina I went to a plastic surgeon and was denied.
Now i'm waiting to see if a surgeon will be approved. It is medically
necesary the ICD-9 codes have to be right and they require pictures
Shirley
— Shirley F.
February 17, 2003
i have bcbc of south carolina I went to a plastic surgeon and was denied.
Now i'm waiting to see if a surgeon will be approved. It is medically
necesary the ICD-9 codes have to be right and they require pictures
Shirley
— Shirley F.
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