Question:
How can I look into getting a Abdominoplasty?

I have lost 165lbs and I have this large flap and I have been having back pain and my Dr. has had me on some real strong meds and he told me that I need it but he dose not think that my insurance will pay for it. I have Cigna and if someone can give direction it will help alot.    — Christopher W. (posted on August 16, 2004)

August 16, 2004
My insurance paid for mine (Aetna) most due if you met their qualifications. Check to see if Cigna has their policy on line.. like aetna does; follow the guidelines and Im sure you can get it approved. Same with the Boobs!
   — star .

August 16, 2004
Hi Christopher! I am also with Cigna HMO, and after my PCP put in for an authorization to get a consult with a PS, they denied it, as my doctor only put in that I had a rash, and they figured the rash could be controlled. Well, my problem was just not a rash, but a multitude of problems, including back ache, etc. My husband (an attorney who no longer practices) found Cigna's website and it lists the things where PS is covered. That website is: http://www.obesityhelp.com/morbidobesity/answers1.phtml?N=i1092688937. He was able to write a letter, listing the symptomology I had, and was able to back it up with pictures and a few prescriptions from different doctors for anti-fungal creams, etc. I also was having backaches, and had the vicodin scripts to provide. If I can help you with anything, please let me know. I am a paralegal, and might be able to help you write a letter to give to your doctor to use when he asks for the authorization. You can write me directly at: [email protected]. Good Luck & Continued Success!!!
   — DorrieB

August 17, 2004
The approach you take depends on whether you have an HMO or a PPO/POS/traditional health plan. If you have an HMO, then your primary care doctor has to write a referral for you to a plastic surgeon. If you have a PPO, POS or traditional insurance, then you can go straight to a plastic surgeon for a consultation. Many plastic surgeons do not work with insurance companies at all. Your chances of getting insurance approval for one of them is much smaller than with a doc who will send a request for coverage, and provide medical info and pictures. So, find a plastic surgeon who will work with your insurance company on your behalf. When I was looking for a plastic surgeon, I would ask that question when I called the office, before setting up a consult. I also asked about the doctor's experience in doing abdominoplasties on patients who had lost significant amounts of weight (I wanted one who could deal with my very large pannus expertly). I checked out plastic surgeons on the ObesityHelp site, and I asked my primary care doctor, friends and other WLS patients for referrals. Through all of that (and it took a while and a bunch of phone calls), I found two surgeons with whom I was comfortable. Each submitted a request for coverage to my insurance company. All BC/BS wanted was pictures showing how large the pannus was, and they agreed to cover a panniculectomy (removal of the excess abdominal skin and fat). They would not cover muscle tightening, which is common as that is almost always considered cosmetic (though if you have severe back pain, perhaps strengthening of the abdominal muscles could be justified to help support the back--just a thought). They also would not cover the brachioplasty (removal of the skin on the upper arms). But, by covering the panniculectomy, I got the hospital and anesthesia charges for all of the surgeries covered, which saved me quite a bit of money. I know that some insurance companies require much more documentation of associated medical problems than mine did, but assuming your doc can provide evidence of visits related to skin rashes and the back aches, that may not be a problem for you. Best wishes.
   — Vespa R.

August 17, 2004
I had Aetna, and they paid with no problem. Their criteria was a >100 pound weight loss and a pannus that hung to or below the pubic bone. Add to that your back pain, and I would certainly think that it would be considered medically necessary. Give it a shot, and if they turn you down, appeal. Also, a picture is worth a thousand words. My surgeon sent pictures, and they told the whole story.
   — mom2jtx3