Question:
WILL AETNA USHC PAY FOR ABDOMINOPLASTY OR ONLY PANNICULECTOMY?

My surgeon is insisting that I pay her $1,000.00 and the hospital $750.00 for my abdominoplasty. She says this is to cover the extra work involved in an abdominoplasty as opposed to a panniculectomy. Aetna's policy states that abdominoplasty is covered, however never mentions panniculectomy. I've shown her the coverage policy bulletin on their website and she says the code is the same for both, and Aetna only pays for the panni. She says no insurance company will pay for the Abdominoplasty.Please someone help! I have been on the phone with Aetna and can't get any definite answers as to which procedure they do actually pay for.    — beth N. (posted on July 26, 2002)

July 26, 2002
You didn't say if your insurance was HMO, POS or PPO. I'm going to assume it's one of the 3. The doctor is right in that the procedure code is the same for both procedures. Typically, insurance companies don't cover an abdominoplasty because they stitch up your stomach muscles and that's not medically necessary. The panni is just cutting off the excess skin below the belly button and that would be covered. If you have the HMO, POS or PPO plans with Aetna and this doctor IS part of the Aetna network, you are under NO obligation to pay her anymore then what she and Aetna have contracted for (minus any of your deductibles, copays or coinsurance amounts). You could always have the Provider Relations department at Aetna contact her about this and have them tell her that the abdominoplasty is covered and your not responsible for the extra $!000 she wants to charge you. It sounds like she's going to stand firm and won't sew up your stomach muscles without you paying her the extra money. She seems to be more interested in making a buck which concerns me more then anything. Maybe you should consider seeing another plastic surgeon. This happened to me and I changed doctors and am much happier that I did. Good luck.
   — Patty H.