Question:
Looking for Different Insurance Companies Policies on Reconstructive Surgery

I am making my final appeal to Office of Personnel Management on the denial of my tummy tuck (even though I had a hernia). I have federal blue cross/blue shield and they will not preapprove anything (except hospital stay), so you have to have the surgery and then hope they pay. Their policy is they will pay if its "medically necessary" except they don't tell you want they consider "medically necessary." Anyway as part of my appeal, I want to attack it on two levels. (1) medically necessary based on the hernia and (2) their lack of guidance when it comes to cosmetic vs. reconstructive surgery. I am looking for guidelines/policies from different insurance companies where they specifically state when they (the insurance company) considers an abdominoplasty to be medically necessary and/or the need to have reconstructive surgery pre-approved. If someone has information like this or a link to their insurance plan's policies, please email me. Thanks!!!!    — Lisa N M. (posted on April 16, 2003)

April 16, 2003
Try the coverage bulletins at www.aetna.com. You may have to search, but the have some pretty straight forward guidlines.
   — Beffy W.