Question:
HELP! Ins co approved panni not abdominoplasty

Although both my Doctors requested an abdominoplasty, my insurance company has approved a panniculectomy. Has anyone else had this happen & how did you deal with it? Can I still appeal since the ins co has approved the panni & ask again for the abdominoplasty? I have at least as much loose skin above my waist as below & was really counting on the abdominoplasty to help with that. I'm really wondering if it would be worth all the pain, scars & recovery from the panni if it doesn't really solve my main problems. It's my understanding the panni does nothing to tighten the underlying tissues & muscle, just removes the loose skin. I don't know how effective it would be in my case. I would appreciate any feedback, suggestions or ideas from anyone. Thanks!    — Kathy W. (posted on January 16, 2002)

January 16, 2002
Would your doctor be willing to do both at the same time and then bill your insurance only for the panni, with you paying for the abdomenoplasty? You have to be in the hospital and under anesthesia for both, so you could save the hospital costs.
   — [Anonymous]

January 16, 2002
I had a panni and my surgeon cut me from under my breast to my crotch & from hip to hip. I also was big above my belly button. I am very happy with the results. I also agree with the previous poster. Maybe you could pay the difference.
   — Helen C.

January 16, 2002
I recently had a panniculectomy, and my plastic surgeon was prepared to do an abdominoplasty if he found that the underlying muscle structure needed repair. He requested "panniculectomy/abdominoplasty" from the insurance providers, and stated that the "burden of proof" rests with the surgeon to provide the documentation to support his decision to proceed with an abdominoplasty. In his experience, the insurance providers who had approved panniculectomy initially, also generally approved the abdominoplasty when the documentation supported the medical necessity. He did agree, however, that the patient would be taking a chance in the process, and might end up paying the difference with some insurance providers. I also had the anchor incision due to all the excess skin above the bellybutton. I only needed the panni, and I am ecstatic with the results :-) Good luck!
   — Diana T.

January 17, 2002
Thanks for answering, guys. I am really encouraged by what I've read. Calling for appointment today! Kathy
   — Kathy W.