Another tummy tuck/insurance question

Kayla B.
on 4/25/11 1:53 am - Austin, TX
So, I originally posted about having difficulty finding a plastic surgeon that works with insurance.  It was suggested to start with my insurance and find surgeons that contract with them.

So, I did.

And I started calling...and despite them contracting with my insurance company, all the doctors are refusing to work with insurance for any post-weight loss procedures.

I wasn't even aware this was allowed?

Incredibly frustrated.  Am I able to file on my own at all?
5'9.5" | HW: 368 | SW: 353 | CW: 155 +/- 5 lbs | Angel to kkanne  
Jody ***
on 4/25/11 3:38 am - Brighton, MI
RNY on 10/21/08 with
Is it a covered procedure?  If they're refusing it could be because its not covered, or they have a very difficult time getting paid for it.  Perhaps the amount that the insurance company allows just isn't worth it to the Dr's... I know mine didn't get paid squat... but, he drummed up "out of pocket" business from me when I went back for my BL/BA...

No, you probably aren't allowed to file on your own, as it has to come from a participating Dr...

HW-218/SW-208/CW-126/ Lowest Weight-121/Goal-125 - hit 8/23/09/Height-5'3"

Regain 30 lbs from 2012 to 2016 - got back on track and lost it.  Took 8 months. 
90+/- pounds lost      
BMI - 24 or so
Starting BMI between 35 and 40ish? 
Join us on the Lightweights Board!

Kayla B.
on 4/25/11 5:14 am - Austin, TX
Yes, it is covered when medically necessary.  They don't even call my insurance to check.  They just said they don't do insurance for weight loss related procedures...yet they ARE participating providers in my network.  I don't get it.

I understand that insurance companies reimbursements are crap, but I thought that was the price they paid by being considered in-network.
5'9.5" | HW: 368 | SW: 353 | CW: 155 +/- 5 lbs | Angel to kkanne  
on 4/25/11 5:47 am - Rochester, MI
HI Kayla,

I met with a couple Dr's when searching for my tummy tuck Dr. The first 2 told me on the phone that they dealt with Ins.  Then once at the consults they backtracked and said they didnt deal with it at all. They then proceeded to tell me that no Dr takes ins. or deals with them blah blah. I knew this isnt the truth. He then tried to put me on a payment plan. I walked. I went back to the Dr that did breast lift/augmentation a week later for his consult. After his consult he submitted to Ins with the proper photos and documentation. My insurance called last week and it is covered. I have surgery May 12th. Dont give up and keep searching! Good luck to you!
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