Question:
How do you get insurance to pay for a tummy tuck?
I had a c-section in 2000 and now have pain in my lower area, plus rashes and itching, Ive heard insurance will pay for it, but Im not really sure what to ask for?I have BCBS insurance — jenncombs (posted on May 19, 2004)
May 19, 2004
The fact that you are having pain is a good reason for insurance to cover
it. also most doctors will do a tuck as a "hernia repair". ask
your plastic surgeon to work with you.your pain can qualify as a scar
revision or laporotomy. Good luck!
— traceybubbles
May 19, 2004
any doc who would bill tummy tuck as a hernia repair would be unethical
and could lose their license. if you have an actual hernia, they may repair
it at the same time as the tummy tuck saving on hospital costs etc. By the
way, the insurance co reads the operative report that is required on any
surgery. no doc in their right mind would falsify a legal document such as
that.
— **willow**
May 19, 2004
Willow, I agree with you on the unethical etc. but unless you specifically
sign a release for the surgery report to be sent to your insurance company,
they will not be able to read it. It is YOUR medical record. The release
you sign normally is just for sending bills etc. In the past they could
send this info without your knowledge but no longer with the laws that
changed about last April 2003. A few months ago I even had a doctor send
me a letter asking for approval to send info to my insurance company to get
a claim paid.
— zoedogcbr
May 19, 2004
If they insurance company is being asked to cover a surgery they normally
do NOT cover, they will usually request a letter of medical necessity. The
surgeon then has to spell out exactly what he plans to do and why, so the
operative report is not needed. The surgeon would be in some real hot water
if he said he was going to do one thing and then billed for something else.
He may not get paid by the insurance company, for one thing, and the
patient can't be billed, so he loses out. The non-covered surgery is
usually approved in a computer system and the claims system recognizes the
auth and pays the claim.
— koogy
May 20, 2004
I just got my approval for my tummy tuck and I have Anthem Blue cross. They
said since my tummy hangs below my pubic line and that I went to see my
doctor for back pain and rashes and recieved RX for these and the RX did
not work i was qualified for the surgery. That is how I got approved. Good
Luck. 4/12/2002 lost 190 pounds.....
— sarah C.
May 20, 2004
The best way to get your tummy tuck approved is to STAY ON THE INSURANCE
AND THE DOCTOR!!!! I called my insurance company sometimes three times a
day. Send your plastic surgeon thank you notes and emails so that they do
not forget your face. You have to make your case a priority for both the
doctor and the insurance company. Always be one step ahead. Right down all
of the creams, powders, ointments that you have used. Document back pain.
Already have an appeal letter in your pocket just in case. I got my tummy
tuck to include lipo approved in two days. GOOD LUCK!!!
— Michelle H.
May 22, 2004
Hi. As mentioned below....document everything and realize that they need
MEDICAL NECESSITY to approve surgery. They may want up to 6 months of
non-surgical treatments before they approve, too. On the hernia and
HIPPA....as Willow mentions, doing a hernia is a great time to fix the
tummy, as it saves time and can be done through one incision. I have
"heard" of using legitimate medical conditions to get plastic
surgery done, and this is of course illegal, unethical, and nothing but
trouble for ALL involved. HIPPA does allow release of your medical notes
for several purposes without your consent. Sending your op note to the
insurance or a billing company (which we always do) is one of those
disclosures that can be done without your consent.
— DrL
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