I am a 30yr old female who has been morbitly obese most of my adult life. Over the course of the past year I have lost 165lbs (thru diet and exercise-no surgery couldn't get that approved either). I have 30 lbs left to go before I hit my goal weight. I have been working with a surgeon, pcp, and counselor (image issues, mental health) for a few months now. My insurance company (optima) keeps denying me a tummy tuck. Any other suggestions to help win appeal??
July 19, 2010
Answer: Insurance companies will not pay for tummy tucks. Period.
If you are basing your rationale for an abdominoplasty on 'image issues' there is no conceivable way an insurance company will pay for that operation. In fact, the 'code' for abdominoplasty which surgeons have historically used to 'bill' an insurance company for this procedure no longer exists. Save your energy and quit fighting with your insurance company over this issue. Seek out a board certified plastic surgeon that will work with you on procedure pricing. Alternatively, look into the 'resident's clinics' at the local university medical center's (UVA?) plastic surgery training programs. You may be able to get your tummy tuck at a substantial cost savings and have it performed with a team of supervised plastic surgery trainees.
Helpful
July 19, 2010
Answer: Insurance companies will not pay for tummy tucks. Period.
If you are basing your rationale for an abdominoplasty on 'image issues' there is no conceivable way an insurance company will pay for that operation. In fact, the 'code' for abdominoplasty which surgeons have historically used to 'bill' an insurance company for this procedure no longer exists. Save your energy and quit fighting with your insurance company over this issue. Seek out a board certified plastic surgeon that will work with you on procedure pricing. Alternatively, look into the 'resident's clinics' at the local university medical center's (UVA?) plastic surgery training programs. You may be able to get your tummy tuck at a substantial cost savings and have it performed with a team of supervised plastic surgery trainees.
Helpful
July 20, 2010
Answer: Fighting insurance company for tummy tuck
We wish you luck in your fight. But the reality is this insurance company, Optima, and MOST others deem cosmetic image surgeon a non covered benefit. That is the way it is. So either start saving or go to a University dept of Plastic Surgery for resident in training surgery at very reduced fees. Best of luck on the last 30 pounds!
From MIAMI DR. B
Helpful
July 20, 2010
Answer: Fighting insurance company for tummy tuck
We wish you luck in your fight. But the reality is this insurance company, Optima, and MOST others deem cosmetic image surgeon a non covered benefit. That is the way it is. So either start saving or go to a University dept of Plastic Surgery for resident in training surgery at very reduced fees. Best of luck on the last 30 pounds!
From MIAMI DR. B
Helpful