Question:
What should I do regarding plastic surgery

I have lost a total of 125lb. I have a hernia and was hoping to have a "tummy tuck" along with my hernia repair. the plastic surgeon said that my insurance denied the claim- I have Health Net-formaly PHS. I cannot tell you how devastated I am. I called my INS CO and was informed that no claim was ever presented to them,,,,, QUE?? I then called the P.S and was told that they did not submit the many pictures of my "tummy" because they were told outright that it would be considered cosmetic. ... I am lost as to what to do nxt.. Do I find another P.S who will take the chance and send my photos-- or do I insist that they do it correctly ?? .....To make matters worse I am engaged to be married in less than 3 months ...... so I need help ASAP ... I feel soooo unattractive with this nasty extra skin......... What to do?    — anessa W. (posted on July 18, 2002)

July 17, 2002
I would probably find another plastic surgeon. He should have sent in a letter of medical necessity with pictures to the insurance company. You can always go back and ask him to do it. Tell him you would like a copy of his letter. This way you know he actually wrote the letter and you can send it in with your own pictures and your own letter of why you feel this is medically necessary.
   — Patty H.

July 17, 2002
If they are covering the hernia repair it may be only a couple of hundred dollars more for the surgeon to do a tummy tuck at the same time. The insurance is already paying for the OR and hospital fees.
   — Linda A.

July 17, 2002
I have Health Net formerly PHS and they covered my TT when the packet went with photos and a letter from me stating why the hanging skin should be considered medically necessary. If this p.s. isn't willing to go the full distance for you, then I would find another one. My original wls surgeon did my TT and I am thrilled with the results!! Good luck and don't stop fighting!! That particular p.s. sounds a bit lazy to me. Have a Sparkling Day!! ~CAE~
   — Mustang

July 17, 2002
I agree with Patty and Christine. You PS wants your money but doesn't want to take the extra effort to get your TT approved. Please don't reward his/her laziness.
   — Carmen K.

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