Covered/Uncovered Out of Pocket!

AppleBottom · 06-14-2008, 11:20 AM

Hey all!

My surgeon told me what I have to say to him in Apts. to get my breast lift and excess belly skin removal covered by insurance. If both of those are covered, but I wanted to add in a tummy tuck and a breast augmentation, does anyone know about how much that would be out-of-pocket????

gingerbug · 06-14-2008, 11:46 AM

I dont know but what ARE the magic words for the lift and excess skin?

KD8888 · 06-14-2008, 01:53 PM

I think it depends on the surgeon and the area you live. Call your doctor's office and ask what the cash price for those procedures would be.

By the way, I'd be interested to know what you needed to say as well.

Sue Magoo · 06-14-2008, 02:00 PM

Hi:

Please share those "magic words" with all of us who want to get some coverage for plastic surgery from our insurance.

Thanks.

Sue

AppleBottom · 06-14-2008, 10:44 PM

It was implied that if I complain of back pain from my breasts drooping, that a lift could be covered. If I complain of rashes or skin breakdown under my belly skin, then that would be covered,too.

I heard a girl once say that if you just don't dry under your belly after your shower, you'll get a minor rash, which would be enough for photo documentation. Honest approach? Definately not. Will I do it? Probally!

**Kat817** · 06-15-2008, 12:57 PM

Mostly it depends on your individual insurance. As well as how the procedure is billed. It usually has to be pre approved as a medical necessity as opposed to cosmetic which is usually not covered by most insurance policies. The medical necessity is decided by insurance workers, not a Dr. Makes no sense!

My great niece was mauled by 2 dogs, and the insurance would not cover her surgery to her face or her legs, because while disfiguring it was not medically necessary! The surgeon who did my TT actually did the surgery anyway while my nephew and his wife sued the dogs owners---all of them knowing you cannot get blood from a turnip--but the surgeon did it anyway. Insurance would have let her be scarred for the rest of her life.

My torn abdominal muscle had been documented for well over a decade---repair had always been put off due to my weight. Through the years, I have had problems with skin rashes, as well as the thin skin tearing open, under my apron of skin. When it would not heal, I would go get a round of antibiotics----never really believing I would lose the huge amount of weight, let alone ever get rid of the belly----I thought I was doomed! Well years down the road, the band happened, and the weight lost, and the rashes and tears continued. My PCP referred me to the PS, who made a 10 page packet of information as well as tons of pictures to send to insurance. It just happened that the day he took the pics, I had a skin tear that was open and bleeding, so he documented it as well. Insurance approved me, I had surgery, then they sent a letter saying they were not paying because it was cosmetic. When the Dr. sent in the copy of the pre approval and re submitted the written documentation, they then approved and paid. But it was scary for awhile!

Document everything, but also read the fine print, to be sure it is covered or you might find yourself with a huge medical bill.

I hate dealing with insurance!!! It is so pathetic.....someone sitting at a desk, deciding MY health! Not me and my Dr. I pay all my premiums, and my co pays, and they can still decide if I get health care or not......so stupid!

Kat