Question:
Could you tell me what your insurance was and what requirements you had for a tummy tuck

   — Sassy M. (posted on July 2, 2002)

July 2, 2002
Haven't had it yet (WLS scheduled July 22) but Healthcare Mngmnt Admin. requires (and remember this is my employer's policy not HMA's) that it be medically necessary and not for cosmetic purposes. In other words, that the panni pulls on the lower back creating a bad back or increasing a bad back; that you have chronic fungal infections; rashes; or that it hangs low enough to disrupt normal walking ability. Hope this helps!
   — [Deactivated Member]

July 3, 2002
Most insurance companies aren't going to tell you what there "requirement" is to cover a tt. Everyone would then have those problems!! I used the following: rashes, odor, back pain, can't do things required in "normal" life (i.e., jogging, running, etc). You need to tell them the problems you have living a "normal" life due to the excessive skin in the stomach area. Also, show pictures of the area. The best one to do is standing to the side, grab your stomach and pull it out as far as you can. This REALLY shows how much excess skin you have. I did and they approved me and I'm having my surgery next month!!
   — Patty H.

July 3, 2002
I had Acordia National and CIGNA PPO as insurance providers, and they both approved my panniculectomy and brachioplasty. My secondary provider, CIGNA, approved immediately, with no questions asked, after receipt of the plastic surgeon's letter of medical necessity and photographs. My primary, Acordia, denied the request initially, but approved the surgery following the appeals process which included re-submission of the plastic surgeon's letter and photographs, as well as letters of medical support from my PCP, my bariatric surgeon, and a personal letter of appeal in which I outlined all the reasons that this surgery was important/essential to me. My physicians listed the "co-morbidities" as chronic low back pain, frequent and recurrent rashes and yeast infections in the skin folds (with accompanying pain and odor), restricted normal activities of daily living and inability to participate fully in a prescribed therapeutic exercise regimen. In my letter, I mentioned all of those things, in addition to issues of comfort/appearance/self-esteem/inability to buy clothing of appropriate size for my current weight because of the large abdominal overhang and overly large upper arms. It is unusual for insurance providers to approve brachioplasty (armlift) so I felt very fortunate to have that covered as well. Good luck!
   — Diana T.

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