hernia with tt

Hello everyone!

I am scheduled for a panniulectomy, breast reduction and hernia repair on the 17th.  I was just informed from my insurance company that they will cover the breast reduction and hernia repair but not the panni removal!!!  I understand why they wont because they require me to be at least 18mo post op and have a steady weight for 6 mo.  I am 10mo post op and have had a steady weight for 3 months.  I just found out about the hernia and they have to go in to repair it.  I dont understand why the insurance wont pay to have the skin removed if the surgeon has to go in to repair the hernia anyways.  has anyone ever encountered this before?  I want them all done at the same time so I can get back on my feet and back to work.  Any info or suggestions would help me with figuring out which direction to take. 

Thanks everyone!

The surgeon will bill for everything separately to the insurance.  Your policy outlines specific criteria that you must meet for the panni - you haven't met that criteria.  But the surgeon is still going to drop their charges for each procedure.  Plastic surgeons have very detailed billing charges that they drop, more so than other practicioners I've seen.

It's beyond just a matter of "while I'm in there, I'll just do this too."  Very small minor things, yeah they'll do that.  But when it comes to a bigger procedure, very few will do it for what insurance pays on the other procedures.

You can ask if they'll throw it in for free, but be prepared for no to be the answer.  It's also not just the surgeon's charges, the facility will also have charges as well, particularly equipment used, time in the OR.  Then there's anestethia's billing.  All three bill separately and it's based on the procedures on record being performed.