Aetna and apron removal???

Is there anyone who has had Aetna approve the removal of the extra skin on the lower abdoman(apron)? I have found a surgeon, on Aetna's in network list, but he says they will probably not approve it. Does anyone know a way of getting this done? I have a rash etc but he still thinks they wont cover it.

You may have to document the skin issues over a period of time.  I do not know about Aetna but some will look at skin issues that are persistent .

Red

The best way to start is to call your insurance company and ask if it is covered. The surgery you are looking to have would most likely be what I had.

It is called a Panniculectomy. It is not a tummy tuck. It doesn't involve any muscle tightening at all. 

Ask them to find this surgery in your Summary Plan description.
In my case, it was excluded but I wrote my HR department and got the policy changed for all the subs in my company. I received this surgery and a breast reduction due to my weight loss. If our sub hadn't changed insurance, I could have had more done. That's besides the point.

Start with what is in your policy. If it is in there, ask for the qualifications to have the surgery covered. If they approved your weight loss surgery, there should be some mention of the reconstructive surgeries in your plan. Never call them plastic surgeries to the insurance companies. Also reconstructive.

Let usknow what you find out. Also, ask your HR department who makes the choices of what to cover in your plan, the company or the insurance company. This can make a big difference in getting this covered.

Ask your PCP for documentation of rashes, prescriptions and the like that involve your skin. Did you go to a dermatologist for anything like this? Even though I had just a little documentations of the brown sweat spots, my plastic surgeon wrote a letter stating I did not seek prescription help for rashes, but over the counter solutions. After all, years ago, I never thought I would need any of this paperwork.

Sincerely,
Hope

Aetna paid for my panniculectomy, BUT they are very strict about their requirements.  The biggest one is that you must provide documentation (we sent both written and photographic proof) that the pannus hangs BELOW the pubic bone.  If yours does not, that may be the reason your surgeon is indicating that he doesn't think they will approve it.  Based on other people's experiences, no matter how bad the rashes are, if you don't meet this requirement, they will deny the procedure.

If you meet the first requirement, you will also need to send documentation of several months worth of rashes that you have tried unsuccessfully to treat with prescription creams/powders (I cannnot remember how many months the requirement us, but their clinical bulletin, which is available online, will tell you).   We sent them photographs of the rashes as well.   Aetna does NOT consider any other criteria other than how far it hangs and skin issues (e.g., the clinical bulletin tells you that they specifically do NOT consider "back pain" as a legitimate result of excess skin).

Although they approved the panniculectomy, they did NOT approve the mons lift (even though I had rash issues in the creases where my legs joined my torso), and my surgeon would not combine an insurance-paid procedure with a non-covered procedure, so I had to have two separate surgeries to take care of both areas.

Lora

Hello i have Aetna and i got it approved it was hard work i had an apron but i wanted a tummy tuck to go with so my doctors took pics of how much my skin hung down gave me skin rash cream so for about for about 3 months i seen the doctor he also did my bypass.He told me its all about dx coding but got it approved for a portion of it and paid alittle out of pocket.But it can be done you can also call the insurance company and explain your situation.They can give you advice on what to do as well.Just dont give up.

I have Aetna and I was approved for a full TT  - no problems.

A panni with Aetna is very douable.  First, get your policy coverage for the panni and study it.  Mine wanted documentation with my PCP of rashes or similar plus I kept my receipts for creme the doctor pescribed.  Go to the doc once a month for three months and ensure he documents it in your medical record that you had a rash.  Do take pictures.

Also, the excess skin needs to be hanging to a certain spot and will be in Aetna's policy.  I believe the area the skin needs to go to is basically the start of the hair area "down below."

Good luck,
Jim