How do I convince my insurance company my tummy tuck is medically necessary?
Posted on | February 10, 2012 | 3 Comments
Question by taebae06: How do I convince my insurance company my tummy tuck is medically necessary?
I have a larger hernia and need to have it repaired…problem is I also have a large apron of skin hanging on my abdomen from a 140lb weight loss…Doctor(reg.surgeon) won’t do hernia surgery unless I get tummy tuck.(by plastic surgeon) 2 surgeons one operation…any advice?
Best answer:
Answer by Doctor J
You just explained it beautifully. Put this in writing (send it return receipt to prove the ins. co. got it!) and send it to them. Include in the letter that you will SUE them if they do not cover this medically necessary procedure. If they still deny coverage, SUE them.
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3 Responses to “How do I convince my insurance company my tummy tuck is medically necessary?”
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February 10th, 2012 @ 9:38 pm
Ask your surgeon…he/she should know.
February 10th, 2012 @ 10:30 pm
Your surgeon can write a letter to insurance company that you need a tummy tuck.
February 10th, 2012 @ 10:55 pm
Even if your insurance company approves it, you’re not likely to find a plastic surgeon who will do it for what the insurance company will pay.
We had this where I work – someone actually got approval, but the amount they agreed to pay the surgeon was about a quarter of what he charges, so he refused to do the surgery. It would likely COST him more than that in supplies, staff time, etc. It probably wouldn’t have covered what he pays for malpractice insurance for that day!
You might find a teaching program that would take you on as a patient. They’re less concerned with not losing money than a private practice surgeon is.