Question:
Aetna Insurance and Abdominoplasty/Panniculectomy approval with hernia!

I have Aetna PPO insurance. I have a hernia and am wanting an abdominoplasty/panniculectomy. I also need a breast reduction. I have referral letters from my OB/GYN and my Chiropractor for my breast reduction. I THOUGHT that since I have a hernia, that the insurance would pay for the Tummy Tuck, but my Plastic Surgeon's office doesn't think they will. They say that the insurance company will only pay for the portion that has to do with the hernia repair. They also say that it needs to be referred to as a panniculectomy instead of an abdominoplasty so it would have a better chance of being covered. And the hernia repair is done by a separate doctor at the same time the TT is being done. Does anyone out there have any experience with this kind of situation? I'm wondering what I need to do to get Aetna to pay for the TT as well! Please help me if you can!    — macrobin (posted on July 9, 2003)

July 9, 2003
I have aetna and am waiting to hear if I have been approved. Aetna does cover abdomnioplasty with hernia repair as well as if there is severe rashes and the related the coverage bulletin is on there website. I know each plan is a little different but the ps I went to said aetna has been good in covering with a true hernia, so lets hope thats true :)
   — Laurie B.

July 9, 2003
That's right. The insurance company will be looking at all the CPT codes in order to pay what they feel is "medically necessary" So the hernia is, but the panniculectomy and abdominalplasty needs to be submitted by your PS for review seperately. My panniculectomy was covered and I'm lucky my doc just feels that the abdominalplasty or muscle tightening goes with the package and does that as well. He also fixed my ventural hernia, so it depends on what type of hernia you have if you can get more work done.
   — ZZ S.