Guest guest Posted December 9, 2002 Report Share Posted December 9, 2002 OK Peeps.... Question of the day..... How can I get a hernia so I can have a tummy tuck? OK my friends, hurry along with those answers so I can get started on herniating myself! Judy in the Windy City Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 9, 2002 Report Share Posted December 9, 2002 In a message dated 12/9/2002 9:07:50 PM Pacific Standard Time, motorcyciemama@... writes: > How can I get a hernia so I can have a tummy tuck? Insurance companies are different. My insurance company did not care that I had a hernia, they would not approve the abdominoplasty. In fact, they questioned whether I really had a hernia because they thought I was making it up to try and get coverage (apparently, they thought my PCP and two surgeons were also making it up). I did eventually get coverage for both the hernia and the abdominoplasty, after the surgeries. They required a copy of the surgical notes to cover the hernia, and to cover the abdominoplasty I had to go through multiple appeals and document back pain, hygiene problems, and some heroic efforts to deal with both problems over a series of many months. So, don't start the heavy lifting yet!! Kate Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2002 Report Share Posted December 10, 2002 In a message dated 12/10/2002 9:54:26 AM Eastern Standard Time, motorcyciemama@... writes: > OK Peeps.... > > Question of the day..... How can I get a hernia so I can have a tummy tuck? > > OK my friends, hurry along with those answers so I can get started on > herniating myself! > > Judy in the Windy City ****************************** Hey Judy, I though my constipation might do it, but no such luck. ( in NJ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2002 Report Share Posted December 10, 2002 Ditto...I had a hernia and got denied the tummy tuck. 2 yrs later they approved the tummy tuck without any hernia, yeesh, BlueCross could have saved a bundle letting me have both done at the same time. go figure, same insurance, same surgeons, same PS Hernias are not fun so don't rush into one.. Rita in Brrrmont Was -5 degrees yesterday, I wanna go someplace warm!!! -- In Graduate-OSSG , kateseidel@a... wrote: > In a message dated 12/9/2002 9:07:50 PM Pacific Standard Time, > motorcyciemama@a... writes: > > > How can I get a hernia so I can have a tummy tuck? > > Insurance companies are different. My insurance company did not care that I > had a hernia, they would not approve the abdominoplasty. In fact, they > questioned whether I really had a hernia because they thought I was making it > up to try and get coverage (apparently, they thought my PCP and two surgeons > were also making it up). > > I did eventually get coverage for both the hernia and the abdominoplasty, > after the surgeries. They required a copy of the surgical notes to cover the > hernia, and to cover the abdominoplasty I had to go through multiple appeals > and document back pain, hygiene problems, and some heroic efforts to deal > with both problems over a series of many months. > > So, don't start the heavy lifting yet!! > > Kate > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2002 Report Share Posted December 10, 2002 > In a message dated 12/10/2002 9:54:26 AM Eastern Standard Time, > motorcyciemama@a... writes: > > > OK Peeps.... > > > > Question of the day..... How can I get a hernia so I can have a tummy tuck? > > > > OK my friends, hurry along with those answers so I can get started on > > herniating myself! > > > > Judy in the Windy City > ****************************** > Hey Judy, I though my constipation might do it, but no such luck. : (( > > in NJ > ****************************************** Just come help me pull open/close the roll-up doors in the warehouse I manage. That did the trick for me! Then I started the 18 month fight with BCBS to pay for my TT when they fixed my hernia. I WON! I'm very happy that I did! Reba in Auburn, AL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 10, 2002 Report Share Posted December 10, 2002 You don't need a hernia to get a tummy tuck approved, nor does having a hernia give you a better chance of getting approval. About the only help a hernia would be is that it covers the overnight stay an out of pocket TT doesn't. Actually talking to the plastic surgeons, having a hernia actually can limit the results they can get doing an abdomnioplasty, as mesh repairs can be limiting. We usually (but not always) need to prove medical necessity beyond redundant skin after massive weight loss to get reconstructive plastic surgery approved for insurance coverage. In my case, I had back problems for over 3 years before they finally approved my abdomnioplasty. I was denied in November of 2000 when I was 2 years post op as they said I did not prove medical necessity or that abdomnioplasty would solve any medical problems I had. So, while I was too busy to consider surgery again, I lost another 30 pounds or so, getting my BMI down to about 23 and I also switched to the PPO insurance option throough my husbands company. For 18 more months, I lived on vicodin, visited orthopedic surgeons and physical therapists until I had no choice but to try for abdomnioplasty again or go to the next step of back surgery and/or pain control implant of some type. *I* (I did my research and knew my back might not improve without abdomnial support no matter what I did) had determined medically that I had a better chance of improvement with abdomnioplasty than, back surgery or a narcotic pump/implants alone without abdomnioplasty. The same plastic surgeon I had picked and consulted with before sent the same request for coverage and I was approved first try this time. I had my full abdomnioplasty with total muscle tightening (from breast bone to pubic bone) using the anchor incision and removing 5.5 pounds of excess skin in June. It was like a miracle. He found that I had true diastatis recti and that the lower abdominal muscles were completely separated, 8 inches apart . . . no wonder I had back problems and couldn't do a sit up! I have been off all narcotics since after my last reconstructive surgery the end of July. It is wonderful to feel so much better and have improved appearance to boot! I still have scoliosis and arthritis in my spine, but I can live with it now without needing narcotics to try to get through the day. If we had to pay cash, which I was willing to do, if necessary . . . I was going to sue the insurance company if the abdomnioplasty did in fact greatly improve my back pain. There was no doubt about my medical necessity and my doctors and I had proved it. I think one of the keys to approval is real medical necessity and then a PCP and plastic surgeon to write the proper request and provide the documentation. Good luck! ) Vicki > OK Peeps.... > > Question of the day..... How can I get a hernia so I can have a tummy tuck? > OK my friends, hurry along with those answers so I can get started on > herniating myself! > > Judy in the Windy City > > > Quote Link to comment Share on other sites More sharing options...
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