Question:
Cigna or Aetna more apt to cover plastic surgery?
I am taking on new insurance and would like to know if Aetna or Cigna are better at approving plastic surgery? — Denise V. (posted on April 8, 2003)
April 8, 2003
Here is Aetna's criteria (coverage bulletin CPBA0211):
<p>
Aetna covers abdominoplasty / suction lipectomy according to the following
criteria:
<p>
Panniculus hangs to or below the level of the pubis; <b>and</b>
<br>
The panniculus causes chronic intertrigo (dermatitis occurring on opposed
surfaces of the skin, skin irritation, infection or chafing) that
consistently recurs or remains refractory to appropriate medical therapy
over a period of 3 months
<p>
Coverage may be subject to individual case review and prior approval in
plans with such provisions.
<p>
Aetna covers repair of a true incisional or ventral hernia. Aetna does not
cover an abdominoplasty to repair a diastasis recti, defined as a thinning
out of the anterior abdominal wall fascia, because, according to the
clinical literature, it does not represent a "true" hernia and is
of no clinical significance.
<p>
Coverage may be subject to individual case review and prior approval in
plans with such provisions. When documentation of the medical necessity of
a ventral hernia repair in order to distinguish it from a purely cosmetic
abdominoplasty is requested, Aetna requires documentation of the size of
the hernia, whether the ventral hernia is reducible, whether the hernia is
accompanied by pain or other symptoms, the extent of diastasis (separation)
of rectus abdominus muscles, whether there is a defect (as opposed to mere
thinning) of the abdominal fascia, and confirmation of the presence and
size of a fascial defect by office notes, and either ultrasound or CT scan
of the abdomen.
<p>
From another bulletin on Cosmetic Surgery:
<p>
The following procedures are nearly always considered cosmetic in nature.
<p>
Excision, excessive skin, thigh, leg, hip, buttock, arm, forearm or hand,
submental fat pad, other areas.
<p>
I haven't even looked at PS yet (I have Aetna), but it looks like they'll
cover the abdominoplasty, but nothing else...JR
— John Rushton
April 8, 2003
I just had my abdominopolasty covered by Aetna. They were really good about
it. Go to ossg-plastics for the online support group that focuses on
plastic surgery following WLS and they have lots of info about insurance
companies.
— Vicki L.
April 8, 2003
I just had my arms and TT covered by Aetna. I am working on the rest now.
I also know that Sue Barr had numerous procedures covered by Aetna (I
believe she had to go through the appeals process for some of them though).
Here is her link with a lot of valuable information:
http://www.lvcablemodem.com/njtomato/plastic%20surgery%20.htm
I hope this helps you as much as it helped me. Thanks Sue... if you are
reading this...Sincerely,
Mary Beth
— Beffy W.
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