BCIR And Insurance

The BCIR is a well-known, approved procedure, listed in all the surgical procedure code manuals including Medicare! Many people ask whether surgery to convert a standard conventional ileostomy to the BCIR is covered by health insurance. The answer is YES. The diagnosis is "malfunctioning Brooke ileostomy" which includes both physical problems with an ileostomy as well as emotional or psychological problems dealing with an ileostomy. Just the presence of an ileostomy requiring an external appliance is an approved indication for the BCIR surgery.

This is NOT a cosmetic operation like changing the shape of one's nose or the size of one's breasts! It is an operation to give a person control over the discharge of their intestinal waste, thereby avoiding the need for an external appliance. All health insurance carriers approve this operation. Even Managed Care companies (HMOs) will approve this surgery. Most HMO networks do not have a surgeon who specializes in the BCIR procedure, so approval must be obtained to receive care "out of network". This can take time (even months), but my office staff and I have never failed to obtain such authorization.

We participate actively in the process on your behalf, by telephone calls and by letters to the primary care physician and the Medical Director of the HMO. For indemnity and PPO insurance, all that is needed is the routine pre-authorization done for any patient requiring any type of elective surgery.