I have BCBS Illinois. Would they approve a breast reduction and panniculectomy to be done during same scheduled surgery?

Question

I have back pain, recent weight loss and a rash that keeps developing on my upper thigh region.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding if a panniculectomy can be performed at same time as a breast reduction. Technically, if you are healthy and your plastic surgeon is comfortable performing both your breast reduction and panniculectomy at the same time, these procedures can indeed be done at the same time. However, in regards to insurance coverage, this can be a different matter. They may approve both surgeries, they may deny both surgeries, or they may only approve one surgery.  Either way these are important issues to discuss with your plastic surgeon. Ideally, both your  breast reduction and panniculectomy are approved so you can have both procedures done at the same time. These are questions you need to ask your plastic surgeon and ideally get authorization before surgery for these 2 requested procedures. Thank you for your question if you can combine a panniculectomy with a breast reduction. Thank you!
I hope that I have answered your question regarding combining a panniculectomy with a breast reduction.  I specialize in reconstructive plastic surgery after weight loss.  If you have any more questions regarding the panniculectomy, tummy tuck, extended tummy tuck, high lateral tension tummy tuck, abdominoplasty, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact my office. Since the panniculectomy or extended tummy tuck are big procedures, please seek an experienced, board certified plastic surgeon with significant experience performing the panniculectomy or extended tummy tuck. Do your research.  Make sure they have performed at least 100 panniculectomies or extended tummy tuck 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, panniculectomy or extended tummy tuck surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, 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 and RealSelf Hall of Fame.)

Dhaval M. Patel, MD · Answer

Thank you for your question! All insurance companies are different and cover different things.  I suggest you seek a board certified plastic surgeon and discuss your concerns and let the staff submit a claim to your insurance.  Best of luck!Dr Dhaval Patel
Double Board Certifed 
Plastic Surgeon
Chicago
Hoffman Estates
Oakbrook
Orland Park

Kenneth Hughes, MD · Answer

BRs which are medically necessary (i.e. you suffer back, shoulder, and neck "pain" with DOCUMENTED medical attention over a period of a YEAR) are typically covered by most medical insurance providers.  If not, they may try to deny you based upon a lot of things such as lack of symptoms, lack of previous medical management, and lack of enough tissue that should be removed. The insurance companies will dictate the amount of tissue to be removed, not the PS.  
Some insurance providers will cover the cost of a panniculectomy based upon medical criteria such as chronic skin rashes, wounds, infections, odor, excess skin hanging down below the pubic bone, and other medical issues.  
Read your BCBS Illinois certificate of coverage. Determine what medical information is required for your BCBS Illinois to issue a pre-authorization or predetermination of benefits for the BR and panniculectomy surgeries. Then seek consultation with a board certified plastic surgeon who can evaluate your medical condition, discuss the pros and cons of these surgeries as they apply to you, and help you in completing the required paperwork.  
Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon
Los Angeles, CA

Andre P. Marshall, MD · Answer

Hi and thank you for your question. Each insurance company is different and a lot of what is covered depends on who is reviewing your case and even more importantly the documentation the physician sends to the company regarding the medical necessity of your procedure. Doing both procedures in the same setting is very feasible from a surgeon's perspective-getting insurance to approve it is a different thing. Even if they approve only one of the procedures, paying out of pocket for the other is much better than paying for both. Nonetheless I hope you get both covered and get a fantastic result!

I have BCBS Illinois. Would they approve a breast reduction and panniculectomy to be done during same scheduled surgery?

Answers (4)

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