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.
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