Question:
Aetna states a hernia is no excuse for a TT. So I guess no TT but I need this hernia
fixed as it drives me crazy, Incisional. I am 10 months out and down 117. They dont want to do surgery until I am 18 months out :( has anyone had it done sooner with good results.? — Kathy S. (posted on July 25, 2004)
July 25, 2004
Hi. The hernia could be fixed through the same incision as a tummy tuck,
lessening the number of surgeries you have to undergo, probabably
preventing the use of mesh, and overall adding to your functional and
cosmetic result. It is truly in your best interest to try and do both at
the same time, even if it means self-pay on the TT. A plastic surgeon who
also is boarded in general surgery may be willing to reduce the TT fee. The
hospital and OR fees (in part) plus overnight stay (in full) would be
covered that way too.
— DrL
July 25, 2004
True, but it doesnt mean they dont cover TT. Have you applied? I have
Aetna and BOTH were covered.
— star .
July 25, 2004
Hi. Don't give up so easily on the TT. I was denieed the TT and approved
for my hernia. I appealed and was denied again, so I requested an external
appeal from the State of NY and won. You need to supply a lot of photos
and documentation of your need for the TT. Make sure all your photos are
dated. Good luck!
— Fixnmyself
July 25, 2004
Well, I was not able to cover my TT. I had a huge incisional hernia ---
and it required mesh for repair (due to its size, etc.). I paid a
surgeon's fee, which was much less than a tummy tuck would have been if I
had done it alone. I went to a few plastic surgeon consults and all said
it would be extremely difficult to get mine covered (I even applied once
and it was immediatel denied). Now, my 'panni' was not very large - it
didn't even really 'overhang', so this is why it was not considered
'medically necessary'. I think if you document rashes, etc. - it can be
covered (at least the panni part - not necessarily the muscle tightening).
All the best, Teresa
— Teresa N.
July 26, 2004
I assume your sooner question relates to having a TT at this early stage.
My advice to you would be to WAIT as long as you can to have both done at
the same time. If you have it now, and 8 months later you've lost another
20 or more pounds (which is VERY possible), you are going to have less than
ideal results with your TT. PS's want your weight to be as stable as
possible before having this porceedure. You should too, especially if
you're going to pay out of pocket for part of the surgery. Good luck to
you.
— LMCLILLY
July 26, 2004
I agree...the closest to goal weight is usually the best time to have PS.
Exceptions are patients whose symptoms are so bad that any cosmetic problem
on down the road would be minor in comparison. The larger hernias actually
have a smaller chance of getting "stuck" and strangulating bowel,
but your WLS needs to make this call. Hernia surgery is also easier and
more successful if your weight is down.
— DrL
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