????Confused about Insurance????

I am 2 years post WLS and down 140 pounds.  My surgeon submitted for my skin removal.  I have been notified by my insurance company that I was approved for "Repair Abdominal Hernia" which to my knowledge I don't even have a hernia.  However, I was denied "Excision Excess Skin Removal Abdoninal" as being not medically necessary.  Does anyone know if pannus removal might be lumped in with hernia surgery.  I have not heard from my surgeons office about any of this yet and I plan on calling them when they reopen on Monday..just wondering what others may have run into in getting the "down to the knees belly flaps" removed and covered by insurance.  I didn't know if the doctors may use "select wording" in getting things approved.

Thanks in advance for your input.

I am sorry, but it looks like they denied your skin removal   Just go ahead and appeal it and don't give up! I can't stress that enough.  I have Optima for my health insurance and I was prepared for them to deny my surgery when the PS submitted the claim.  In fact the day I left the PS office after my consult I called the insurance company and got an appeal packet.  I ended up submitting a 47 page appeal.  ( letters from my doctors saying it was medical necessary, office visits from right after the surgery to present, physical therapy records etc)  Optima ended up approving the abdominalplasty, but denied the hernia repair??? and "excision of the excess skin".  The excision of the excess skin was the dog ears on the hips and mine did not say anything about the abdomen on that part.  So I had to pay a thousand for that little part and needless to say they paid for the hernia repair which was the size of a cantelope!   Please don't give up this is how insurance companies make money.  You have to appeal it!  I wish you the best of luck and if you need help or have a question about anything please feel free to send me a message.

I have optima health but keep telling for them to cover the surgery it has be medically necessary. My doctors office said they don't deem anything medically necessary. Did have to go thru this for them to cover your surgery? I'm thinking if I meet the criteria and complete the requirements that should be enough. Just curious how you found out optima health was going to pay for your surgery. Thanks a bunch!

Unfortunately, that "excision excess skin removal" that got denied is the panniculectomy.

Your best bet is to find out if your insurance compnay has ANY provision for medical necessity for pannus removal (if they don't -- and many do not -- you're probably out of luck, since a panniculectomy takes a while and cannot be "hidden" as part of the hernia procedure...  whihc would be insurance fraud, anyway).  If they WILL cover it if they determine it to be medically necessary, find out what the requirements are for showing medical necessity.  (It is usually a documented history of skin rashes under the fold and having the skin hang down below the pubic area.)  Then you will know what you need in order to appeal the denial.

Lora