Question:
How should I get documentation for showing an abdominoplasty is medically necessary?

I checked Aetna's website regarding coverage of abdominoplasty after weight loss. It says they will cover it if "Panniculus hangs to or below the level of the pubis; and The panniculus causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs or remains refractory to appropriate medical therapy over a period of 3 months" (taken straight from there website) Also under cosmetic surgery it says they will cover it if "Abdominal lipectomy: When abdominal folds cause symptoms such as chronic pain, dermatitis, or ulceration." Well, I have had lower back pain for a long time, although I am not sure if it is caused by my stomach. I have also never seen my doctor for this because I just figured it was something I had to live with. Any suggestions on what I should do? Should I see my PCP so I can get some documentation started, and, if so, what should I tell him? Thanks for your help    — Michele :. (posted on April 25, 2002)

April 25, 2002
Hi... I am 3 wks post op but prior to surgery I had a panni problem due to prev. abdominal surgeries, Csection, etc. My Dr. began with the last irritation which included a small boil to document every time I have a rash, an inflamation, boil, etc. She said I should call her office when I have one too even if she prescribes something again I have, over the counter etc. as she will then document the need based on history when the time comes for an abdominoplasty which for me will probably be in about 12-14 months. Do the same with rashes under breasts, on backside etc. It could mean insurance may cover it with recurring problems. Good luck to you.
   — AJC750

April 25, 2002
Check my profile. I have all the criteria there.
   — [Deactivated Member]

April 25, 2002
Denise B. is a pro at this so I would listen to her advice. I would also get with your surgeon - he has been through this, I'm sure, and knows the proper wording to use. Best of luck to you. Hugs, Sharon Robinson
   — Sharon R.

April 25, 2002
If you are having any problems of any kind which might be caused by your panni, go see your doctor about them. A lot of it is still going to be based on your insurance policy, but it can't hurt to get the problems documented and it might hurt not to.
   — garw

September 4, 2005
Hi! I have Aetna and I was approved in less than one week. I had BC/BS last year and was denied. I would strongly suggest you get as much documentation as you can. I started with a letter from my PC. Funny how things work out. I had to find a new Primary Doctor because my old one didn't take Aetna, had to find a new plastic surgeon because the old one didn't take Aetna. I started with my new PC, she wrote a letter of recommendation, I documented all the rashes, all the treatment plans, the length of time suffering from this problem. I then went on to an orthopedic doctor. Had an MRI which confirmed degenerative disk disease. He also wrote a letter of medical necessity for the abdominoplasty. My final stop was at the surgeon's office. I could not have been more Blessed than to stumble across this doctor. His office & the hospital is an hour away from my home but it was well worth the trips. The doctor knew EXACTLY how to word his letter of recommendation and I tell ya, Aetna, I can not complain about any longer. Like I said, they approved me (to my complete and utter shock and surprise) under a week. I was given a surgery date of Sept. 15, 2005 and was called about 2 weeks ago asking if I wanted Sept. 2, 2005 as there was a cancellation. I took it. I had my surgery on Friday, was kept over night for observation and discharged yesterday. I can not believe the difference in my body. All I can recommend is to NEVER give up. Keep calling, write letters, never give up on yourself. Blessings to All. Lois
   — Lois B.

October 2, 2005
Finally...I got my "Tips for Getting Your Plastic Surgery Approved" worksheet on my website. It will help individuals who have medically necessary issues get their plastic surgery covered, at least in part, by insurance. Check www.drlomonaco.com under "Patient Resources"
   — DrL