Has anyone gotten TT approved due to back pain?

valjuan16
on 7/28/09 9:20 am - PASADENA, CA
I am tiring to find a way to get a TT paid for by my insurance.  I was told if it is medically necessary they would approve it.  I called the insurance company.  I have had back surgery before WLS.  Lost 117lbs.  I have very weak stomach muscles from two open stomach surgery's prior to WLS (gallbladder and total hysterectomy with an 9 in vertical cut).  My lower back has begun to hurt again, and the disc re-herniated after I lost the weight.  I do have some hanging skin on my stomach as well.  The lady at the insurance company said that if the doctor felt that surgery was necessary to tighten the stomach muscles to improve chronic back pain, it could be approved for the plastic surgery.

My questions was, has anyone had a similar experience and gotten their TT approved in this manor?  If so, would you be willing to share what wording was used or anything that would help me get it approved.  Thank you for your help.

Val
God is good all the time!!

Gastric Bypass Dr. Troy La Mar  03/12/08
Anchor Cut,  Extended Tummy Tuck  Dr. Pearlman D. Hicks 12/17/10
Starting weight 265, Goal Weight 130, Current Weight 145.
sanguinarythorn
on 7/28/09 10:32 am - Newport News, VA
I didn't have back trouble, but I didn't have a "medical necessity" either and it was still approved. I sent along a long, heart felt letter with the application package my surgeon's office sent to insurance, and apparently it worked (to my ultimate surprise, as you can imagine). My surgeon told me that insurance companies are totally unpredictable... and from their experience, it's almost like a "shot in the dark" when they send in application packages.  

They told me though that if I did have a "medical necessity" to get documentation from the specialists I saw about it, detailing what the necessity was and how it would be improved by the skin removal. Your specialist should know the correct jargon to use to pluck the right strings.
Jupiter6
on 7/28/09 12:29 pm - Near Media, Pa- South of Philly, NJ
Usually they will cover the pannus but not the muscle repair.

 "Oh sweet and sour Jesus, that is GOOD!" - Stephen Colbert  Lap RNY 7/07-- Lap Gallbladder 5/08--  
     Emergency Bowel Repair
6/08 -Dr. Meilahn, Temple U.  
 Upper and Lower Bleph/Lower Face Lift 
12/08 
     Fraxel Repair 2/09-- Lower Bleph Re-Do 5/09  -Dr. Pontell, Media PA  Mastopexy/Massive 
     Brachioplasty/ Extended Abdominoplasty 
(plus Mons Lift and Upper Leg lift) / Hernia Repair
      6/24/09 ---Butt Lift and Lateral Thighplasty Scheduled 7/6/10
 - Dr. Ivor Kaplan VA Beach
      
Total Cost: $33,500   Start wt: 368   RNY wt: 300  Goal wt: 150   Current wt: 148.2  BMI: 24.7

valjuan16
on 7/28/09 4:32 pm - PASADENA, CA
Thank you both for your responses.  I will try to get as much documentation as I can.

Val
God is good all the time!!

Gastric Bypass Dr. Troy La Mar  03/12/08
Anchor Cut,  Extended Tummy Tuck  Dr. Pearlman D. Hicks 12/17/10
Starting weight 265, Goal Weight 130, Current Weight 145.
dmoore1162
on 7/28/09 10:28 pm
lower back pain is one of the medically necessary reasons to have an abdominalplasty.  Not sure about the muscle tighting - but the removal of the skin. 
Delores Moore
it's never too late
    
Most Active
×