Insurance to pay for Tummy Tuck??

ExplorinLauren
ExplorinLauren Posts: 991 Member
in Chit-Chat
I wasn't sure of where to post this...

I've been wanting a tummy tuck for 17 years. I've been waiting patiently :)
Now, after 4 children, getting healthy, losing weight and getting my ducks in a row.... It will FINALLY happen in March 2013.
I've followed several tummy tuck threads, and I see that SOMETIMES it is covered by insurance, as a tummy tuck or Panniculectomy ....whatever. lol
My question is... How?? Is there something you have to say directly? Does it take months/years of fighting with an insurance company? Do I have to prove something? What do I need to do, or what steps do I need to take, to TRY to have it covered (fully, or partially, I don't care) by insurance?
Thanks! :)

Replies

  • BridgeKiki
    BridgeKiki Posts: 48
    I don't know but I sure am trying to find out.
    Thanks for your post.
  • xtina1129
    xtina1129 Posts: 111 Member
    will visit this later, as I'd like to know too!
  • jennfranklin
    jennfranklin Posts: 434 Member
    I believe the only time they will pay is if there is a health concern involved. It is considered cosmetic surgery!
  • michellekicks
    michellekicks Posts: 3,624 Member
    I would guess you'd have to have such a significant fold of skin remaining that bacteria breeds within it... like it folds right over.
  • twanthe1
    twanthe1 Posts: 407
    Looks like Aetna does:

    http://www.aetna.com/cpb/medical/data/200_299/0211.html
  • Barbellerella
    Barbellerella Posts: 1,838 Member
    Ask your surgeon. Usually they will submit it if they think you have a chance, or they will give you the paperwork. I think it would only be covered if the abdominal muscles are actually separated from the abdominal wall, but its still a shot in the dark.
  • thatonepersonfromtheinternet
    thatonepersonfromtheinternet Posts: 136 Member
    Most insurance companies won't really cover cosmetic surgery. So unless you have a medical reason to do it (eg, it causes you severe back or knee issues), they won't cover it.
  • iulia_maddie
    iulia_maddie Posts: 2,780 Member
    I believe it's only covered if it causes health issues(such as separated muscles). If it's just loose skin, most likely not.
  • twanthe1
    twanthe1 Posts: 407
    I.
    Aetna considers panniculectomy/apronectomy medically necessary according to the following criteria:
    A.Panniculus hangs below the level of the pubis; and
    B.
    The medical records document that the panniculus causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs over 3 months while receiving appropriate medical therapy (e.g., oral or topical prescription medication), or remains refractory to appropriate medical therapy over a period of 3 months.


    Aetna considers panniculectomy/apronectomy cosmetic when these criteria are not met.

    Aetna considers panniculectomy/apronectomy experimental and investigational for minimizing the risk of hernia formation or recurrence. There is inadequate evidence that pannus contributes to hernia formation. The primary cause of hernia formation is an abdominal wall defect or weakness, not a pulling effect from a large or redundant pannus.

    II.
    Aetna considers repair of a true incisional or ventral hernia medically necessary.

    III.Aetna considers repair of a diastasis recti, defined as a thinning out of the anterior abdominal wall fascia, not medically necessary because, according to the clinical literature, it does not represent a "true" hernia and is of no clinical significance.

    IV.
    Aetna considers abdominoplasty, suction lipectomy, or lipoabdominoplasty cosmetic.
  • chuckponygirl
    chuckponygirl Posts: 53
    I know 2 people that had the surgery covered. It has to do with things like if you get skin infections under your belly where the skin hangs. It needs to be documented by a doctor.

    If you get skin infections there then I guess you need to get to the doc. so he can document.

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