Question:
Hi, can you tell me what kind of things make a tummy tuck medically necessary? Thank
— SJP (posted on December 4, 2004)
December 3, 2004
Hi if You have gotten this far CONGRATULATIONS!!! Now Some insurances say
that if it hangs below Your pelvic area they will pay others require rashes
all are pretty differant soooo Best Wishes
— Shell G
December 4, 2004
Rashes, skin ulcers, back and neck pain, trouble sleeping on your stomach,
problems exercising, problems with balance ect.
— Lacy G.
December 4, 2004
Dear SJP,
It can be quite challenging to get an insurance company to pay for a TT.
Most carriers see this operation as "cosmetic" and require there
be what is called a diagnosis, or ICD-9 code to justify the operation. The
most common diagnoses include an intertriginous infection (under the skin
fold), persistant rash, skin ulceration or an incisional hernia. Your
surgeon will usually need to write a letter to the insurance company with
photographs stating that your operation is medically necessary based on the
diagnosis. I hope this information is useful to you. Joshua Kreithen,
M.D. Lakewood Ranch Plastic Surgery, Bradenton FL -
www.lakewoodranchplasticsurgery.com
— Joshua Kreithen, M.D.
December 4, 2004
It's all about what teh companies define as "medical necessity."
Your documentation of skin problems, back problems, and problems with odor
will go a long way to get a decision quickly. Most companies want at least
several months of documented teratment of these problems before they OK the
surgery.
— DrL
December 5, 2004
Hi! Send me an e-mail and I will send you a copy of my abdominoplasty
appeal letter. Got mine approved (and got the criteria changed) even though
my plan had an exclusion for "panniculectomies and similiar
surgeries" after weight loss surgery. I can also send the American
Academy of Plastic Surgeon's postition statements on Abdominplasty and
Redundant skin.
— koogy
December 5, 2004
I agree with comments below. I will also state you need to be at least 1
year to 18 months post op. Have lost the bulk of your weight and be at a
stable weight for 4 months.
— Linda R.
December 5, 2004
I agree with the comments that all the others have made. Look at my
profile to see what I did to help my appeal along. Document everything
with your Drs.. I had letters from my PCP, dermatologist, WLS and PS. I
also had my husband take pictures of my rashes. One thing that was
mentioned in my appeal reversal letter was that my pictures weren't dated.
If you can date stamp your pictures, do it. You never know what may help.
Be prepared for a denial at first. My PS told me that, as did my WLS. My
PS also mentioned that most external reviews are won, since they are
reviewed by other PS doctors, and these doctors often have cases sent for
review that they themselves want to be approved. It is a bit of work to do
it, but it can be accomplished if you are persistant.
— Fixnmyself
December 6, 2004
I heard that if you express to your doctor that you have a rash or soars
due to the excess amount of skin, you will be able to receive a tummy tuck.
HINT: if you spread dry soap consistently around your stomach, under the
folds of skin, it will appear that you have a rash and then you can show
your doctor your problem.
— Michelle M.
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