Insurance and reconstructive surgeries

girllovedcupcakes

I have a total of 200 to loose and I am down 55 so far. I will need some nip tuck work done for sagging skin. We are currently doing our annual enrollment and I was wondering of any of you have experience with Aetna EPO or Premera Blue Cross Medical PPO. It seems a bit odd but when I looked at the policies the more expensive insurance says they will not cover any type of reconstructive surgeries but the less expensive one will? Have any of you had success with either of these insurance companies?

Premera Blue Cross Medical PPO
Cosmetic Services
Services and supplies (including drugs) rendered for
cosmetic purposes and plastic surgery, whether
cosmetic or reconstructive in nature, regardless of
whether rendered to restore, improve, correct or
alter the appearance or shape of a body structure,
including any direct or indirect complications and
aftereffects thereof.
The only exceptions to this exclusion are:
Repair of a defect that's the direct result of an injury,
providing such repair is started within 12 months of
the date of the injury
Repair of a dependent child's congenital anomaly
Reconstructive breast surgery in connection with a
mastectomy as specified under the Mastectomy and
Breast Reconstruction Services benefit
Correction of functional disorders upon our review
and approval

Aetna EPO
Reconstructive or Cosmetic Surgery and Supplies
Covered expenses include charges made by a physician, hospital, or surgery center for reconstructive services and
supplies, including:
Surgery needed to improve a significant functional impairment of a body part.
Surgery to correct the result of an accidental injury, including subsequent related or staged surgery, provided that
the surgery occurs no more than 24 months after the original injury. For a covered child, the time period for
coverage may be extended through age 18.
Surgery to correct the result of an injury that occurred during a covered surgical procedure provided that the
reconstructive surgery occurs no more than 24 months after the original injury.
Note: Injuries that occur as a result of a medical (i.e., non surgical) treatment are not considered accidental injuries,
even if unplanned or unexpected.
Surgery to correct a gross anatomical defect present at birth or appearing after birth (but not the result of an
illness or injury) when
the defect results in severe facial disfigurement, or
The defect results in significant functional impairment and the surgery is needed to improve function
Reconstructive Breast Surgery
Covered expenses include reconstruction of the breast on which a mastectomy was performed, including an implant
and areolar reconstruction. Also included is surgery on a healthy breast to make it symmetrical with the reconstructed
breast and physical therapy to treat complications of mastectomy, including lymphedema.
Important Notice
A benefit maximum may apply to reconstructive or cosmetic surgery services. Please refer to the Schedule of Benefits.

TrailRunner61

I had a breast reduction and lift with BCBS of IL, PPO plan. They paid for all but $25.00.

cherbapp

I don't have either of those but it looks like neither will cover a tummy tuck.

My insurance will cover a tummy tuck if there are rashes that have proven resistant to treatment for a year, and one other problem like back pain, etc, or the skin flap hangs below the pubic bone.

I have no rash...so I'm out.