Aetna and TT approval questions?

Hey there everyone!

I am just starting to look in to PS after a 145 pound weigtht loss.  My question is that the policy states this : 

Aetna considers panniculectomy medically necessary according to the following criteria:

1. Panniculus hangs below the level of the pubis; and

2. The medical records document that the panniculus causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs over 3 months while receiving appropriate medical therapy, or remains refractory to appropriate medical therapy over a period of 3 months.

Aetna considers panniculectomy cosmetic when these criteria are not met.

Below the level of the pubis?  Thats very vague.  Are they saying completely below, or does it mean below the start of the pubic bone, the mons pubis, it doesnt state.  Has anyone had any luck getting approval without having an apron of skin hanging?
i am definatley not even close to some of the worst cases, but i definatley have skin hanging over my pubis and tend to get rashes from under it to inner thigh.

Thank you for any advice you can give! :)

It means it has to hang where you cannot see the pubic area.  I have a very large pannis and it hung to my mid thigh.  I also had documented rashes with things the doctor's prescribed that didn't work.  You should start to see your PCP because it must be documented at minumum 3 months in a row.  They will not approve a TT.  You can pay the difference, but they will not pay for the muscle portion of the surgery.

Generally, you will need to send photos so they can determine.  i have had them approve skin that does not hang so low on several occassions.

Most importantly, though, is to have documented visits to the doctor for the required 3 months for medications to treat the rashes.