Question:
Aetna insurance,,,they say hernia is no reason to have TT.anyone get approved with

Aetna for hernia repair and TT?Thanks... By the way...My birthday is Sat..1 Year and at goal...    — Kathy S. (posted on September 16, 2004)

September 16, 2004
I had a hernia repair and abdominosplasy paid for by Aetna. Didnt have any trouble with it.. BUT I think that was because I was 'approved' first by BCBS and got married and changed over to Aetna before I could have my TT.. Hard for Aetna to say it wasnt medicaly necessary when another carrier just said it was. But I did get it covered. Had MORE trouble with the breast lift. One thing about Aenta is that they do not use their 'guidelines' as guidelines they use them as a check list for coverage. Lucky for me my husbands company has the 'last' say on all denials from Aetna. The company medical director override Aenta and they paid for my BL. So apply for the TT see what they say; appeal if necessary and go thru the WHOLE process... hopefully you'll get it covered. or if aetna says NO your company will say YES>
   — star .

September 16, 2004
I had a BIG hernia repair with general surgeon, alongside full abdominoplasty by a plastic surgeon, (working in tandem)& cut almost all the way around like a LBL with 17 pounds removed ...all paid for by Aetna HMO. I did have to get pictures taken by the PS/also pics I had (digital of course) of rashes that I had documented, everytime I got a red mark I made a pic of it! It took 3 months to get it approved, they gave the PS office the run around but in the end...its done...my tummy is so flat its concave. So we thank the insurance company once again for doing what they should do EVERY time, provide needed services to their policyholders!! What a concept!
   — donnalawbabe

September 16, 2004
I can't address Aetna specifically, but it is true in general that a hernia and tummy tuck are unrelated surgeries, and needing one does not require the other. It may be that they will approve coverage for both procedures, or only the hernia. I have BC/BS and they approved coverage for a hernia repair and panniculectomy (removal of the excess abdominal skin only--no muscle tightening). They approved the panniculectomy because I had a large pannus that hung about 1/3 of the way down my thighs. They did not cover the muscle tightening portion of the extended abdominoplasty that I had done. However, by covering the hernia and panniculectomy portions, they did cover the hospital charges and most of the anesthesia charges, which made a huge difference for me.
   — Vespa R.

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