Question:
Aetna and Tummy Tuck

I have Aetna. For those of you with Aetna who were approved for TT how long did it take and what critera did you have to meet? I will be 1 year post op on 8/7/03. My surgeon wants to discuss TT when I see him on 8/14. I want to have all my ducks in a row. I have seen my PCP once for rashes (about a month ago). I know they require 3 months documented rash problems. Do I need to go back to PCP for stronger Rx before I see my surgeon - I'm still fighting the rash. Do I need to get PCP to write a letter to surgeon recommending TT? And what about tightening he ab muscles? I've had 2 verticle C-sections - no musce tone at all. A year ago I never thought I would be willing to go under he knife again (open RNY) - but this has to go - and I'm ready and willing. Thanks.    — Margaret G. (posted on July 24, 2003)

July 24, 2003
I copied the following from the Aetna site: Policy Aetna covers abdominoplasty / suction lipectomy according to the following criteria: 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 Coverage may be subject to individual case review and prior approval in plans with such provisions. You can find more information at: http://www.aetna.com/cpb/data/CPBA0211.html I hope this helps.
   — Pamela B.

July 25, 2003
Where did you ever get that information about 3 months of documentation of rash? That's not true! Insurance company's just want proof of treatment for rash. I just had a full TT on July 8th and my surgery was covered 100%. I'd submitted notes from chiropractor stating lower back pain, my PCP submitted letter stating weight loss and treatment for rash, I'd submitted personal letter explaining my life experience living with hanging skin, and my PS submitted photos and letter with all the procedure coding. I can email you copies of my letters if you like. Just email me at [email protected] and I will send it to you.
   — Jeanette D.