My BC/BS insurance DECLINED Fat Grafting

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Dogsneverlie
Dogsneverlie Member Posts: 278
edited October 2014 in Breast Reconstruction

Hi all,

I just spoke with PS office and BC/BS declined FG.  They have filed an appeal but they are saying they do not cover FG.  So unreal......we go through so much and just want to feel normal.  I don't need implants, just need some fullness back.  Would they rather I do several surgical procedures and cost them more money or just have a FG procedure done? 

Anyone else go through this?  If so, did insurance eventually approve?  My PS office said they will go as far as doing a peer group review to get it approved.

Thank you!

Donna

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  • SunnyC
    SunnyC Member Posts: 75
    edited October 2014

    Hi Donna

    My BC/BS plan denied the FlexHD used in my reconstruction.  All $17,500 of it.  We are filing an appeal but you are right, we go through SO MUCH and then to deal with this .... it's just too much some days.  

    Good luck with your appeal, I hope you make progress.

    Cynthia

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  • jenjenl
    jenjenl Member Posts: 948
    edited October 2014

    i hope they get this resolved, i have bcbs and have had 3 fat grafting surgeries. 

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited October 2014

    I wonder if the denial is based on you not having reconstruction.  As of the moment I believe that they will only cover it as a revision to existing reconstruction - because of the way it is coded, but will not cover it as reconstruction itself because it is still not FDA approved for that, and as such, deemed experimental by many insurance companies.

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  • Dogsneverlie
    Dogsneverlie Member Posts: 278
    edited October 2014

    I am sad to think that I will not be able to correct my treated breast...........

    SpecialK - what you have written makes sense.  I just don't understand why I would have to have a major surgical procedure such as some kind of implant to correct something I believe so easily corrected............I am feeling sorry for myself now!  Don't like feeling that way.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited October 2014

    dogs - how insurance views revision, and what they will cover, is an ever changing thing.  Just because they don't cover it now doesn't mean they never will.  Fat grafting as a primary method of recon is pretty new, and it is important to remember that fat grafting does not always work, nor is it always a single procedure - it often takes several tries -  and there is no guarantee that the fat will not reabsorb.  My insurance did not cover Mammaprint testing - also termed it "experimental" even though it was FDA approved at the time, but I believe that it is now pretty routinely covered by most imsurance plans, sometimes even after they have paid for an Oncotype Dx test.  As more data is gathered about fat grafting, and newer techniques are improved, it is entirely possible that it will also be routinely covered as a primary method of reconstruction.

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