In need of some help..

HeatherP1978
on 1/27/14 4:32 am

I'm from Missouri and I am having the hardest time finding a plastic surgeon that will accept insurance for a tummy tuck.  My insurance (Tricare) is willing to pay with proof of medical necessity, however, I cannot find a surgeon that doesnt consider a tummy tuck to be cosmetic.  Is there anyone in here from Missouri that got their tummy tuck covered by insurance?  I have been down the list of surgeons provided thru my Insurance and still have had no luck.

            
PetHairMagnet
on 1/27/14 10:14 am
RNY on 05/13/13

Are you required to stay in your state? 

I can tell you that my insurance last year and the policy I have this year are SUPER tough for PS. You have to have a panni that hangs down past your pubis, documented infections and a letter of necessity from the PCP. I think there is a BMI requirement of normal as well, so anyone still overweight would not be eligible. Are you 100% clear on the requirements and does the PS determine the medical necessity or does your PCP via insurance guidelines?

    

HW333--SW 289--GW of 160 5' 11" woman.  I only know the way I know & when you ask for input/advice, you'll get the way I've been successful through my surgeon & nutritionist. Please consult your surgeon & nutritionist for how to do it their way.  Biggest regret? Not doing this 10 years ago! Every day is better than the day before...and it was a pretty great day!

        

    

    

DrL
on 1/28/14 6:09 am - Houston, TX

Hi and congrats on your weight loss.

If you have had 3 months of skin infections and have been to the doctor and prescribed medication that fails to correct the problem, insurance will often cover the excess skin if it covers the pubic area.  Check your exact plan language, but this is the requirement for most insurance plans.   Getting a PS to do the work if getting harder. Many are now out of network on the plans, so again check and see if your benefits make this a worthwhile route for you to pursue with an out of net doctor.   Remember that tummy tucks SHOULD include skin removal PLUS muscle tightening, new belly button, pubic lift as needed, and all associated areas of liposuction on the tummy.  Insurance considers all of the "PLUS" things cosmetic and will not cover them.  Many PS are going to expect payment for those items too.  Consider a University program if possible, as they may be more open to working with insurance.   
John LoMonaco, M.D., F.A.C.S.
Plastic Surgery
Houston, Texas

www.DrLoMonaco.com
www.BodyLiftHouston.com
Amy W.
on 1/29/14 9:31 pm - Buckeye, AZ
Well if it's not causing you infections in the skin folds then it IS cosmetic...

5" 7' -  HW: 328 Current: I stay around 155 :) 
"...Because when you stop and look around, this life is pretty amazing."


 
 
 
 
 
  

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