I am having fibroid removal surgery. When I was examined, it was also discovered that I have a small hernia and lots of scar tissue from previous surgeries. Is it possible to have the fibroid removal, hernia repair and a tummy tuck covered by insurance if it is considered a scar revision?
Insurance Coverage Possible for Fibroid Removal, Hernia Repair, Tummy Tuck?
Doctor Answers 4
Insurance coverage is possible for these surgeries
In situations where scar tissue is present due to previous surgery, insurance may cover a portion of the surgery. It would need to be done at the same setting as the fibroid removal by your OB/GYN surgeon. You should also have your Plastic Surgeon get a letter of preauthorization from your insurance company before the procedure. If you have private insurance, it would be worth your while to check ahead of time. If you have an HMO or Medicaid, don't even bother, as neither will cover the procedure.
Insurance for tummy tuck and breast reduction
Although the insurance will pay for the fibroid and possibly a scar revision they will consider the tummy tuck purely cosmetic and you would be responsible for not only the surgical fee but also the OR and anesthesia fees as there will be additional time in the operating room and anesthesia. Even if they pay for the scar revision they don't pay what the surgeon bills and may only pay 500.00 for the scar revision. I know of no plastic surgeon willing to do the procedure for that price and if he or she is willing to fraudulently bill the insurance for your surgery, what else are they doing?
Discuss the fees with your doctor and come to a reasonable fee. I am sure you will be very happy in the end.
Steven Schuster MD FACS
Insurance and TT
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Insurance coverage for cosmetic procedures
The best way to determine if insurance will cover a procedure is to obtain precertification. All insurance companies are different so the answeres may be different. You should never expect your doctor to fudge the precertification or expect the doctor to state things that he does not believe or to frankly lie. This is unethical and illegal. I would even caution you to not have someone like that treat you because if he is willing to compromise on ethics in one situation he may do the same when it comes to your care.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.