If HMO Doesn't Inform Me of a Hernia for 4 Years Are They Required to Pay for Tummy Tuck?

asked 1 year ago by belly2011 in fremont, ca
Latest answer by Jason Brett Lichten, MD
Question viewed 523 times
Tags: abdomen, hernia, insurance

I went to Kaiser in 2006 for an ctscan due to pain in my abdominal area. I returned in 2010 and demanded another ctscan. I was then informed that I had an abdominal hernia since 2006 which grew. The physicians ( a total of 3) admitted in the initial doctor's notes that he never informed me. I now have a fatty lump and will soon have surgery. Can I make Kaiser perform/pay for my tummy tuck surgery. How will I ever have better abdominal structure/muscles now. I don't want to have to pay for it.

9 answers to If HMO Doesn't Inform Me of a Hernia for 4 Years Are They Required to Pay for Tummy Tuck?

Tummy tuck is a cosmetic operation

I think Dr. Cavali hit the nail on the head. A tummy tuck or an abdominoplasty is a cosmetic operation. If you wish to discuss your concerns with the plan administrator and try to get them to pay for it, then more power to you. I wish you the best of luck, but realize that this is no different than you telling Kaiser that since they missed your hernia they should pay for your new wardrobe.

Jason Brett Lichten, MD
Columbus Plastic Surgeon

Missed abdominal hernia with progression of disease

I would approach the plan administrator or appeal to the medical director with an appeal letter discussing your concerns and requests. This could take some time but I would pursue this until you had a satisfactory answer.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Kaiser Permanente payment for "tummy tuck"

Read the contract between you and Kaiser Permanente thoroughly to determine your rights and responsibilities, and armed with this information, approach Kaiser administration or write them with your request.

Steve Laverson, MD
San Diego Plastic Surgeon

feelbeautiful.com

Wow

In a world where it's "fair" for you to get a free tummy tuck in exchange for a "missed" hernia diagnosis, then I should be entitled to a brand new Maserati when my Camry gets an oil leak that's not fixed the first time. A tummy tuck does not fix a hernia. A tummy tuck is cosmetic and not covered by insurance. Your hernia repair should be covered by insurance, so you might pursue that.

Carmen Kavali, MD
Atlanta Plastic Surgeon

Tummy Tuck surgery is not required to fix a hernia

I'm going to drop the usual diplomacy for a moment ask the following rhetorical question: why on Earth would you feel entitled do a free cosmetic operation (tummy tuck) simply because your HMO 'missed' you abdominal hernia? This line of reasoning behind this question is baffling on so many levels. First of all- an abdominal hernia is not repaired using an abdominoplasty approach. Hernias can be fixed laparoscopically, or via an 'open' approach. If an... more

Scott Sattler, MD
Bellevue Plastic Surgeon

If HMO Doesn't Inform Me of a Hernia for 4 Years Are They Required to Pay for Tummy Tuck

Funny Dr Aldea, and he is right!. You should realize even if the HMO approved the hernia repair they would only authorize the direct incision approach NOT a tummy tuck incision. So you will have to pay for that part of the tummy tuck or cosmetic portion NO MATTER what you feel. Sorry. I believe you but insurance companies DO NOT CARE!

Darryl J. Blinski, MD
Miami Plastic Surgeon

NO

The hernia can be repaired without doing a tummy tuck. A tummy tuck is a cosmetic operation and usually not covered by any insurance.

William B. Rosenblatt, MD
New York Plastic Surgeon

Keiser HMO Doesn't Inform Me of a Hernia for 4 Years Are They Required to Pay for Tummy Tuck?

Regarding:"If HMO Doesn't Inform Me of a Hernia for 4 Years Are They Required to Pay for Tummy Tuck? I went to Kaiser in 2006 for an ctscan due to pain in my abdominal area. I returned in 2010 and demanded another ctscan. I was then informed that I had an abdominal hernia since 2006 which grew. The physicians ( a total of 3) admitted in the initial doctor's notes that he never informed me. I now have a fatty lump and will soon have surgery. Can I make Kaiser perform/pay... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Tummy Tuck and Hernia Repair

Basically, the hernia and tummy tuck are two separate procedures. Many times, I will repair a hernia at the same time as the tummy tuck. However, the hernia repair is reconstructive and the tummy tuck is cosmetic. So, I highly doubt that your insurance company will agree to pay for the cosmetic portion. Good luck.