Question:
How to get by a plastics exclusion?

My insurance (Aetna-Chickering) will not cover my thigh lift due to the exclusion for gastric bypass in my insurance. They state even though it has been deemed medically necessary, they wont cover it because it is as a result of gastric bypass and is cosmetic, an excluded service. I have tried once and appealed and denied again. Any suggestions or am I sunk?    — Carla M. (posted on April 19, 2005)

April 19, 2005
I dont think there not covering it because of your gastric bypass. If you had lost weight on your own, you would still have the same problem with hanging skin. The reason they aren't covering it is because they think it's cosmetic. You need to show them that it's not. If you have documented rashes on your thighs, problems with spraying urine when you urinate, etc. these problems show that it's not cosmetic but medically necessary for you to have the thigh lift. I can tell you that you will probably have a very hard time in getting them to cover this surgery unless you have a LOT of excess skin to be removed.
   — Patty H.

April 19, 2005
I agree with Patty. Prove its medically needed by documenting visits to your doctor for skin irritation and breakdown that does not respond to powders/creams/etc. and you have a chance at coverage.
   — DrL

April 20, 2005
original poster here.. the ins. co. have told me the reason they are not covering it is due to the exclusion for gastric bypass..
   — Carla M.