Are near any insurance companies that will cover abdominoplasty ?
Insurance companies are operate by your fellow humans. It is they who don't care.
Call your state's Department of Insurance and ask for their assistance. I hope your company give in.
mbrcatz have no business being critical of you. That is a poor trait.
If you attain your doctor(s) to write letters to the insurance company stating that the procedure is medically requisite - including the dangers if it is not done - the insurance company will have another look at. It sounds like they are seeing "cosmetic surgeon" and react without thinking, which insurance companies are tremendously good at doing. Insurance companies see it as elective. If in that is one that does not your doctor would have a better grasp. But you can not a moment ago sign up for insurance and then take an operation. It is not designed to work that way.
Answers: Ok, here is what I found about your problem on Aetna's website, which probably isn't what sympathetic of insurance you have, but it still give us a general impression of how insurances view your condition. It looks close to to me, what you are needing is a "ventral hernia repair", not an abdominoplasty. Insurances see the word "abdominoplasty" and say aloud, nope, that's a cosmetic surgery. So have your dr's remove that word from the papers requesting an appeal. It looks close to insurances will cover this as long as its medically necessary and not newly for a cosmetic reason. And according to Aetna, they won't cover it of late based on the reality that it "might" happen because here is no evidence that having the muscles separated manifestly cause a hernia. They won't income for it if your abdominal muscles have separated and it lone looks like a hernia is protruding, but it really isn't a true hernia. Towards the bottom, it say what has to be documented by your dr. contained by order for them to money for it such as the size of the hernia, whether or not surgery would be able to cut back it, etc. I'll just copy and smooth mixture all the info below and you can see for yourself. It looks approaching to me, your insurance will probably pay for it if your doctor uses the right wording. But you involve to get them to seize "abdominoplasty" off the form. Good luck to you and I hope this help!
Clinical Policy Bulletin:
Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair
Number: 0211
Policy
Aetna considers panniculectomy medically necessary according to the following criteria:
Panniculus hang below the level of the pubis; and
The medical store document that the panniculus causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recur over 3 months while receiving appropriate medical psychiatric help, or remains refractory to appropriate medical therapy over a term of 3 months.
Aetna considers panniculectomy cosmetic when these criteria are not met.
Aetna considers panniculectomy experimental and investigational for minimizing the risk of hernia formation or recurrence. There is no modest evidence that pannus contributes to hernia formation. The primary cause of hernia formation is an abdominal wall fault or weakness, not a pulling effect from a hulking or redundant pannus.
Aetna considers repair of a true incisional or ventral hernia medically necessary.
Aetna considers repair of a diastasis recti, defined as a thinning out of the anterior abdominal wall fascia, not medically basic because, according to the clinical literature, it does not represent a "true" hernia and is of no clinical significance.
Aetna considers abdominoplasty, suction lipectomy, or lipoabdominoplasty cosmetic.
Background
In order to distinguish a ventral hernia repair from a purely cosmetic abdominoplasty, Aetna requires documentation of the size of the hernia, whether the ventral hernia is reducible, whether the hernia is accompany by pain or other symptoms, the extent of diastasis (separation) of rectus abdominus muscles, whether at hand is a defect (as dead set against mere thinning) of the abdominal fascia, and office record indicating the presence and size of the fascial defect.
Abdominoplasty, certain more commonly as a "tummy tuck," is a surgical procedure to remove excess skin and fat from the middle and lower belly and to tighten the muscles of the abdominal wall. The procedure can improve cosmesis by reducing the protrusion of the tummy. However, abdominoplasty is considered by Aetna to be cosmetic because it is not associated with functional improvements.
You obligation to take copies of adjectives the letters from the docs, and appeal again, and distribute a complaint letter to your state insurance commissioner.
You ALSO call for to go ahead and own this done, and worry give or take a few how to pay for it subsequently.
It boggles my mind when people hold a life threatening situation, but decline to take the coincidence to pay for it themselves - they'd a bit die, than pay for their own medical exactness.