Hernia/Tummy Tuck Help!

Innerautumn
Innerautumn Posts: 120 Member
in Health and Weight Loss
I visited a general surgeon today who told me that I have an umbilical and ventral hernia. I also have diastasis recti (ab muscles are separated). He told me that he can take care of the hernias but not the diastasis. This is repaired by sewing the muscles back together and is done as a part of a tummy tuck. He says if I do not fit the diastasis, it will become worse as I age. He said that the weak stomach muscles can cause low back pain and have been connected with urinary and bowel problems. He says that ALL ab exercises are off limits until I get the diastasis repaired. Working those muscles makes it worse. I called plastic surgeons and they told me that they can (and often do) fix hernias while doing tummy tuck surgery. THe problem is NONE of the plastic surgeons I called (and I called about 20!) accept insurance. My insurance would pay for the hernia repair alone. Shouldn't they pay for at least part of the surgery to fix all of it? I can understand them not wanting to cover the skin removal as that is cosmetic, but the rest is medically necessary. Does anyone know who I can talk to about this?

Replies

  • Innerautumn
    Innerautumn Posts: 120 Member
    Nobody has any advice?
  • jeme3
    jeme3 Posts: 355 Member
    Get a referral from your regular doctor, the surgeon you met with, or the hospital. Talk to your insurance company, they may know of docs in your area who accept your insurance, or may be willing to send the check to you to pay for the surgery.
  • LordBear
    LordBear Posts: 239 Member
    not sure bout the insurance and all... but u need to talk to a doc. and have him do the referals and such... the loose skin is not just a cosmetic issue.. it can cause mental issues as well as become unsafe in certain work enviroments, create rashes and is unsightly which can cause u not to get jobs etc.. .. in any case it is a health issue as well.
  • Innerautumn
    Innerautumn Posts: 120 Member
    Thanks for the advice! My insurance company gave me the name of several doctors in Vegas who accept Blue Cross. When I called them, they were more dermatologists/plastic surgeons and did not do tummy tucks. The loose skin is not as severe as many people have. There is no overlap of skin, no rashes. It really only bothers me when I am doing push-ups because it hangs in a really nasty way. I am mostly concerned about the musle and hernia repair. I am a school teacher so I don't think it really affects me career wise. The general surgeon I saw wants to do the hernia repair himself. I hope he cooperates concerning the referral. The plastic surgeon that I liked the most said they want paid in full before the surgery and I can pay someone else to file all the insurance papers and the insurance company MAY or MAY NOT pay me back. It seems like there should be an easier way.
  • mcfish618
    mcfish618 Posts: 48 Member
    Many times insurance will not pay if a portion of the surgery can be considered "cosmetic" even if medically needed if it can be deemed as cosmetic they won’t pay for the medical portion if done at the same time. Speak to the office manager or insurance person there at the surgeons office and ask them to file a "pre-determination of benefits" this is where they write to your insurance carrier the exact CPT codes of what surgery's will be done with the exact diagnosis or reason as to why this is needed and the insurance will then review and send you a letter in writing as to what portion is covered and what they will not cover. If you disagree with their decision then you appeal the pre-d in writing with more or any additional information you have to support why this is medically necessary.
  • Innerautumn
    Innerautumn Posts: 120 Member
    Great advice! I will take notes on all this so I can take it with me to my consultation. Thanks so much for the suggestions!
  • pmc1712
    pmc1712 Posts: 2
    hi there. i'm currently working through the insurance side of my impending TT (for the same reasons as you separation/hernia)
    i'm not sure i can help with the insurance side of things as i'm in australia but thought i'd say hi anyhow. i'm looking at having my operation next year around february.
  • BridgeKiki
    BridgeKiki Posts: 48
    Thank you for writing this. I am wondering if you are getting this paid for or not. I have the same type of stomach as your do. Good luck with everything.
  • irishkiss
    irishkiss Posts: 115 Member
    Ive never heard of a surgeon not taking insurance, especially blue cross, as they are pretty good! All the plastic guys here take insurance. They have to take ER call, so facial fractures and car injurys, burns, etc. come in and insurance pays for it. I work in surgery and bill insurance companies and they have paid for tummy tucks along with hernias. Your situation sounds so strange, I cant imagine not taking insurance. You definitely want the plastic guy to do the tuck though! Good Luck!

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