Turned down by insurance for abdominoplasty

My abdominoplasty was turned down by insurance (Humana). I'm really down about it but not going to give up! I haven't had any problems such as back pain or excessive yeast underneath the abdominal apron. I'm so meticulous about my hygiene that the least amount of redness or yeast I notice I go to work getting rid of it. Anyone have any suggestions for an appeal? Dr. Wagstrom said they should pay but unfortunately I got the dreaded denial letter today. Anyone else have problems getting insurance to pay? How much does it cost anyway to get it done without insurance?

Thanks in advance for any advice!
Janie

Steve is going through the exact same thing, with Humana!  I think you should not give up either...  I bet that its their first blanket response, and if a person gives up...  insurance doesn't have to pay!  Do you know what your policy says about what they consider as medically necessary (when they will cover abdominoplasty)?  My policy had specific statements, and my pictures proved one of the requirements so they did cover mine.  (I have BC).  Good luck...  I am not sure how much Dr. Wagstrom charges.  Perhaps Steve can help you there. 

Thanks for responding Mel! I don't know the first thing about going back to the insurance. The only thing that I've had problems with is back pain but they don't see that as a problem. Of course being a nurse doesn't help my back pain constantly pulling and tugging on patients. They could construe that as the cause of my back pain and not my hanging belly! They say that I don't have the documentation of a medical complication from the excessive skin such as dermatitis that is unresponsive to medical therapy as required by Humana guidelines. I just haven't got anything to even support my back pain.  I'm not sure where to start, Mel! Is Dr. Wagstrom's office helping Steve with his appeal?

Thanks again!
Janie

Janie, Steve just found out yesterday or the day before...  I don't think he's talked to Dr. W's office yet but hopefully he will weigh in on the subject real soon.  Does your panni hang down to the pubic bone?  That would be a factor to help you on your case....  Can you actually get your hands on your policy?  I dont know about other insurances, but BC has an online coverage manual that outlines the things they consider as medically necessary for certain procedures.  Ask Humana if there is ANY other reason that they would cover it...  

I recently had abdominoplasty, my insurance paid for it. They say if you have a medical reason for the surgery that they would pay for it, and when you do have a problem like yeast. Like I did, we were surprised that my insurance paid at all. It costs around $10,000 to get it done. Well that's what I was told anyway. Just keep trying. What I did, I sent a letter telling my insurance company  that i have done everything that the doctors' have asked me to do and even more. Tell them that your not going to go back to which you came. That's what I did. I really don't know it that helped or not, But it doesn't hurt to try.

Sincerly,

Robin

When you say you go to work on any problem as soon as you notice it...are you using any prescription products on it? If you are, perhaps you can get documentation of how often you have had to get the script and use that to help document a recurring problem with infection.

In your letter of appeal to the insurance company, I would make a point of being a nurse and knowing how to keep a yeast infection from getting out of control.

Just a thought anyway.

Push the insurance company to reconsider your case. Don't give up!

When I went to talk to Dr Wagstrum, my insurance also would not cover the abdominoplasty so the price that was quoted was about $6500, not including a overnight stay.

If you wanted to stay the night or there were issues, then it was an additional $750.00

I hope that this helps.

Michael.

Thanks all! i will definitely take into consideration all the info you've given me in writing my appeal letter! I haven't had any prescriptions to take care of yeast, just good ol' soap and water and cornstarch powder.

Michael, I appreciate the cost that was quoted to you. I will talk to Dr. Wagstrom's office and see if there is anything they can suggest in my letter of appeal. I have Care Credit so i'll see what they will do for me as well.  But I refuse to give up on insurance until I've exhausted all that's been done to get them to cover it! It may take me a while but I'm going to keep trying. 


Janie