Will BCBS of GA ppo pay for body lift or tummy tuck? I'm 31 year old female have lost over 160 pounds (Photo)

Hi Amandaboley12, Thank you for your question regarding whether BCBS of GA PPO pays for a body lift or tummy tuck, since you are a 31-year-old female who has lost over 160 pounds. Congratulations on your weight loss! Great accomplishment.Thank you for your history and your pictures. To get an accurate assessment of your specific needs, schedule a free virtual consultation. Most plastic surgeons offer free virtual consultations. Without a physical examination, we should analyze your single picture to determine the best procedures. Given your history of 160-pound weight loss, most plastic surgeons would suggest a 360 circumferential lower body lift. The 360 circumferential lower body lift is an all-encompassing procedure that includes an extended tummy tuck, umbilicoplasty, mons lift and reduction, rectus abdominis plication, hip lift and reduction, and buttock lift and reduction. An extended tummy tuck does not include the hip lift and reduction, or a buttock lift and reduction. Now that we know what procedure you need, we will approach BCBS of GA PPO. Insurance approval for reconstructive plastic surgery after massive weight loss is complex. Factors to consider are BCBS of GA policies. BCBS of GA policies can be found on their website. Usually, insurance companies do not care how much weight you have lost. Insurance companies are usually looking for a BMI less than 30, the abdominal skin needs to cover the mons, and chronic rashes unresponsive to creams and steroids. Sometimes the apnniculectomy is covered, sometimes the abdominoplasty (tummy tuck). Rarely do insurance companies cover the 360 circumferential lower body lift. If you want to try to obtain insurance authorization for a panniculectomy or tummy tuck, you need to document these rashes with pictures and supplemental medical records. You will also need a letter of medical necessity for your abdominoplasty from your plastic surgeon. However, in the end, it is entirely up to your insurance if they are willing to pay for a panniculectomy or tummy tuck.
I hope that I have answered your question regarding whether BCBS of GA PPO pays for a body lift or tummy tuck, since you are a 31-year-old female who has lost over 160 pounds. If you have any more questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please get in touch with an experienced plastic surgeon. Since the body lift is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the lower body lift. Do your research. Make sure they have performed at least 150 circumferential lower body lift surgeries and have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. If you cannot find an experienced, lower-body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS, FASMBS (President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Insurance may not cover a full tummy tuck, but you may get coverage for a panniculectomy,  which is removal of the redundant skin of the lower abdomen, without the plication of the muscles or relocation of the belly button. You need to have all your symptoms well documented by your PCP and pictures that show the severity of the skin problems. On some occasions even a thigh lift and brachioplasty can be cover if the patient has hidradenitis, which is inflammation of the sweat glands. Consult a Board Certified Plastic Surgeon with in your plan who has experience in weight loss patients. They can help you through the process.

Usually not a covered benefit or only very partially covered. You still will need to pay out of pocket $

Thank you for including a photograph and kudos for attaining such a tremendous weight loss!  Insurance companies vary in their coverage for body contouring after weight loss.  They will sometimes cover a panniculectomy (removal of overhanging abdominal tissue apron) when there is recurrent infection or skin breakdown that cannot be effectively controlled by more conservative means (topical anti-fungal creams/powders, etc.), or when there is an underlying hernia.  This is not a cosmetic procedure--it does not remove the maximal amount of skin, and it does not tighten the separated muscles of the abdominal wall.  Insurance companies almost always exclude procedures like a tummy tuck or body lift, which do remove larger amounts of skin and restore the integrity of the muscles.  From your photographs, you would benefit much more from a tummy tuck or body lift because they are much more powerful procedures to re-contour the tissues to your frame.  My best advice is to obtain a copy of your insurance policy (either hard copy or online), and read through the portions relevant to panniculectomy and cosmetic procedures so that you know what is covered.  Schedule a consultation with a board-certified plastic surgeon with this knowledge in hand.  Although ultimately this may be an out-of-pocket expense, many plastic surgeons have other financing options such as CareCredit.  My best wishes to you as you navigate your way through all of this!