Question:
The doctor found two incisional hernias when he did my tummy tuck,

my question involves the fact that my insurance denied paying for my tummy tuck becaused they determined it not medically necessary,even though 3 other docs thought it should have been.I submitted proof of rashes and such,well they still denied it.So i took out a $5000 loan and prepaid for the surgery,while doing the tummy tuck the doc found two incisional hernias resulting from my bariatric surgery, both of which me and my doc could not feel prior to surgery because i still has a lot of fat and skin left in my belly area. Will the insurance reimburse me for any part of this surgery? Maybe the OR ,anestesia,and hospital overnight stay? Has anyone run into this situation?What steps do i take or does my doc submit something?I have bluecross federal employee insurance. Thanks for you help!!    — natalie J. (posted on June 14, 2005)

June 14, 2005
May be may be not. You went into the surgery with the insurance company saying that they would not pay for the PS, so in effect your hernias were not precertified to have that surgery performed. In other words they did not approve for you to have the hernia surgery done. Maybe another person that has an insurance background in precertification could answer your question and of course you can call your provider and ask your questions.
   — ChristineB

June 14, 2005
If it were me I would submit it and hope for the best but not be upset if they refused. My hernia repair was done in an emergency basis due to an intestinal obstruction caused by the hernia so it was paid without precert because it was a life threatening emergency. In your case you and your Dr. were not even aware they were there and they weren't causing a problem so the ins might say the repair was not medically necessary. When the general surgeon repaired my hernia he placed mesh, but did not repair the muscle defect, I had to pay for that myself when I had my TT. My PS said the general surgon did not fix it because insurance does not reimburse for the muscle repair.
   — **willow**