Question:
Please read this and tell me what you think, insurance coverage
for tummy tuck, here is a word for word paragraph of what is in my insurance book regarding coverage for reconstructive surgery please tell me your thoughts. Medical Limitations & Exclusions Cosmetic Surgery, ETC... - Any surgery, service, drug or supply designed to improve the appearance of an individual by alteration of a physical characteristic which is within the broad range of normal but which may be considered unpleasing or unsightly, except for: reconstructive surgery necessitated by an accidental injury; or services provided to comply with the requirements of the womens health and cancer rights act (i.e., reconstructive of the breast on which a mastectomy has been performed or surgery and reconstruction of the other breast to produce symmetrical appearance, and physical complications of all stages of a mastectomy, including lymphedemas). coverage will be provided for such care as determined by the attending physician in consultation with the patient and which begins within three (3) years following a mastectomy; or necessary to correct a congenital abnormality in a covered dependent child. note: examples of cosmetic surgeries which are not covered include: surgery for saggy or extra skin, any procedure utilizing an implant which does not alter physiological funtions, unless medically necessary. — Deanna Wise (posted on March 3, 2003)
March 3, 2003
Looks to me like it is not covered, but you can always try to get it
covered under medical necessity if the extra skin has recurrent infections.
Strictly for looks is probably not going to be covered.
— koogy
March 3, 2003
Deana,<br><p>
Do not give up re-read your policy <br><p>
examples of cosmetic surgeries which are not covered include: surgery for
saggy or extra skin, any procedure utilizing an implant which does not
alter physiological funtions, unless medically necessary.
<br><p>
This is not cosmeticit is reconstructive. Remeber that. You have to prove
to your insurance company that the redundant skin is causing problems with
the way you function physiological . You have to show them that the skin
impairs your life physiologically. <br><p>
I am fighting my insurance company now for the same reason and I had to
show them that it is affecting my physiologic function (walking, lifting,
working,fitting in clothes, hygiene (body odor), etc...<br><p>
You will have to fight them. No matter what your policy says you have to
fight them. DO NOT GIVE UP. I will keep you updated on my appeal. They
should make a decision by this Friday. Good Luck.<br><p>
— Skyedancer4u1
March 3, 2003
Medically necessary... that seems to be the qualifier. If plastic surgery
were strictly cosmetic I could understand the denial (I wouldn't like it,
but understand the insurance co's point), but this is medically necessary.
If you get recurring infections it is serious. But...be prepared to
document, document, document.
— Diane S.
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