Question:
looking for appeal letter for TT breats lift approval

I have paid out of pocket for an upcoming tummy tuck, hernia repair and breast lift. I am looking for copies of successful appeal letters to the insurance company to get reimbursed for all or any part of surgery. Also, any icd-9 codes and their definitions used would be helpful and greatly appreciated.    — Kathy831 (posted on March 31, 2005)

March 31, 2005
You should never have to pay for the hernia repair. That is covered by the insurance no matter what as that is a medical condition that is considered a medical necessity to repair. Check with your doctor and have them call the insurance company regarding this and get this approved for you.
   — Patty H.

March 31, 2005
Patty, Thanks for your answer. I mis-stated the question. The hernia is being done "free" by the surgeon doing the TT and lift. I am looking to get the TT & lift covered all or in part. Thanks for your answer.
   — Kathy831

April 1, 2005
Oftentimes a tummy tuck is paid for IF there is a hernia repair as well. It's all in how they bill it. Tonya
   — T S.

April 1, 2005
Hi. Most TT and breast lift will be denied unless you can document medical necessity of the procedures. You and your surgeon or PCP need to develop a clear strategy to create an appeal that details the medical problems the excess skin is causing you.
   — DrL

April 1, 2005
shouldn't your Doctor be submitting and working on this?
   — **willow**