Question:
How do you get insurance to pay for a tummy tuck?

I had a c-section in 2000 and now have pain in my lower area, plus rashes and itching, Ive heard insurance will pay for it, but Im not really sure what to ask for?I have BCBS insurance    — jenncombs (posted on May 19, 2004)

May 19, 2004
The fact that you are having pain is a good reason for insurance to cover it. also most doctors will do a tuck as a "hernia repair". ask your plastic surgeon to work with you.your pain can qualify as a scar revision or laporotomy. Good luck!
   — traceybubbles

May 19, 2004
any doc who would bill tummy tuck as a hernia repair would be unethical and could lose their license. if you have an actual hernia, they may repair it at the same time as the tummy tuck saving on hospital costs etc. By the way, the insurance co reads the operative report that is required on any surgery. no doc in their right mind would falsify a legal document such as that.
   — **willow**

May 19, 2004
Willow, I agree with you on the unethical etc. but unless you specifically sign a release for the surgery report to be sent to your insurance company, they will not be able to read it. It is YOUR medical record. The release you sign normally is just for sending bills etc. In the past they could send this info without your knowledge but no longer with the laws that changed about last April 2003. A few months ago I even had a doctor send me a letter asking for approval to send info to my insurance company to get a claim paid.
   — zoedogcbr

May 19, 2004
If they insurance company is being asked to cover a surgery they normally do NOT cover, they will usually request a letter of medical necessity. The surgeon then has to spell out exactly what he plans to do and why, so the operative report is not needed. The surgeon would be in some real hot water if he said he was going to do one thing and then billed for something else. He may not get paid by the insurance company, for one thing, and the patient can't be billed, so he loses out. The non-covered surgery is usually approved in a computer system and the claims system recognizes the auth and pays the claim.
   — koogy

May 20, 2004
I just got my approval for my tummy tuck and I have Anthem Blue cross. They said since my tummy hangs below my pubic line and that I went to see my doctor for back pain and rashes and recieved RX for these and the RX did not work i was qualified for the surgery. That is how I got approved. Good Luck. 4/12/2002 lost 190 pounds.....
   — sarah C.

May 20, 2004
The best way to get your tummy tuck approved is to STAY ON THE INSURANCE AND THE DOCTOR!!!! I called my insurance company sometimes three times a day. Send your plastic surgeon thank you notes and emails so that they do not forget your face. You have to make your case a priority for both the doctor and the insurance company. Always be one step ahead. Right down all of the creams, powders, ointments that you have used. Document back pain. Already have an appeal letter in your pocket just in case. I got my tummy tuck to include lipo approved in two days. GOOD LUCK!!!
   — Michelle H.

May 22, 2004
Hi. As mentioned below....document everything and realize that they need MEDICAL NECESSITY to approve surgery. They may want up to 6 months of non-surgical treatments before they approve, too. On the hernia and HIPPA....as Willow mentions, doing a hernia is a great time to fix the tummy, as it saves time and can be done through one incision. I have "heard" of using legitimate medical conditions to get plastic surgery done, and this is of course illegal, unethical, and nothing but trouble for ALL involved. HIPPA does allow release of your medical notes for several purposes without your consent. Sending your op note to the insurance or a billing company (which we always do) is one of those disclosures that can be done without your consent.
   — DrL