|
|
Registered User
Currently Offline
|
Posts: 24
Join Date: Jun 2009
|
|
Ok, here is what I found about your problem on Aetna's website, which probably isn't what kind of insurance you have, but it still gives us a general idea of how insurances view your condition. It looks like to me, what you are needing is a "ventral hernia repair", not an abdominoplasty. Insurances see the word "abdominoplasty" and say, nope, that's a cosmetic surgery. So have your dr's remove that word from the papers requesting an appeal. It looks like insurances will cover this as long as its medically necessary and not just for a cosmetic reason. And according to Aetna, they won't cover it just based on the fact that it "might" happen because there is no evidence that having the muscles separated definitely cause a hernia. They won't pay for it if your abdominal muscles have separated and it only looks like a hernia is protruding, but it really isn't a true hernia. Towards the bottom, it says what has to be documented by your dr. in order for them to pay for it such as the size of the hernia, whether or not surgery would be able to reduce it, etc. I'll just copy and paste all the info below and you can see for yourself. It looks like to me, your insurance will probably pay for it if your doctor uses the right wording. But you need to get them to get "abdominoplasty" off the form. Good luck to you and I hope this helps!
|
