Question:
I have a consultation with a PS scheduled and I want to have the abdominoplasty

because I read that fat and excess skin can be removed. I also read a post that most insurance won't pay for the abdominoplasty but will more then likely pay for the panni-whatever it's called. I would appreciate samples of appeal letters for those who won their approval for the abdomionplasty.    — bbjnay (posted on May 2, 2003)

May 2, 2003
My insurance paid about 1/2. Good lux
   — Robert L.

May 2, 2003
My plastic surgeon defines "tummy tuck" as a generic term for one of two procedures: panniculectomy or abdominoplasty. Panniculectomy is the removal of excess skin and fat ONLY, with no reconstructive work being done to underlying abdominal muscles. Abdominoplasty is the exact same procedure PLUS tightening or repair of abdominal muscles and/or hernias. He states that he always requests abdominoplasty when dealing with insurance providers because there is often no way of knowing if muscle repair will be needed until those muscles are actually visualized during surgery. If he discovers that the muscles are in good condition, then he only performs the panniculectomy which makes both patient and insurance provider happy since the panni is a shorter and less expensive procedure (in his practice). His theory is that if he asks for the simpler procedure first, then has to perform the more expensive procedure, then the insurance company may be more likely to refuse payment. That was what happened in my case 18 months ago. After a 140 lb. weight loss, two previous C-section childbirths, and a traditional abdominal hysterectomy with vertical incision, I would have bet money that my abdominal muscles were "shot". However, my plastic surgeon was pleasantly surprised to find them in "darn good condition", so he performed the panniculectomy only. He also did a a brachioplasty at the same time and my primary and secondary insurance providers paid for everything. I think that the initial request from the surgeon to the insurance company, and how it is worded, is a critical piece of this puzzle....discuss this thoroughly with your surgeon and be certain that he describes the surgery as "reconstructive" instead of cosmetic. Best wishes!
   — Diana T.

May 4, 2003
I am going thru the same process right now I see my pcp on friday. Any ways email me back i have some info tht will help get qualified thru insurance.
   — sheri B.

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