Question:
Anyone have a medical necessity letter for a hernia and hanging panis?

I have a ventral hernia and my plastic surgeon is recommending repairing the ventral hernia and performing an abdominoplasty at the same time. I know that Aetna Open Access HMO has a clear line of what's approved for the abdominoplasty; panis that hangs to your pubis (mine hangs borderline to the pubis) AND dematitis that has been documented. I have not had the dematitis, but have the hernia and back pain for years that my primary physician has documented. Does anyone have a letter to send along with the request for the sugery I could use? Or any ideas at all? Thank you! My email is [email protected] for any help, information you can send me.    — [Deactivated Member] (posted on July 6, 2004)

July 6, 2004
A hernia should be easy to get covered. Your surgeon should be handling sending the letter for medical necessity. I am sure he has done it before and will do it again. the insurance company will not take your word on medical necessity with out hearing from the doctor anyways. The dr should also send pictures of the pannus to speed up approval for that. If the doc is not cooperative then change doctors and find one who will. the first Plastic surgeon I saw was not thrilled to work with insurance, apparently he prefers to work with self pays. I went to a different doc and was almost immediately approved for a TT. I had a ventral hernia repaired on an emergency basis last fall due to a bowel obstruction and there was no question on that. it was done prior to approval due to the emergency nature of the surgery.
   — **willow**