Medically Necessary?

[pongomp 1]

Hi everyone! I was banded in April and have since lost 81 pounds. My insurance will cover a Tummy Tuck after weight loss surgery if 80 pounds or more is lost and the tummy tuck is deemed to be medically necessary.

I am meeting with a plastic surgeon on Friday. Can anyone explain what constitutes, "medically necessary"? I don't think that I have any problems other than the sagging is annoying..but I don't know if it is medically causing any problems?

Unfortunately my insurance is changing in Janaury and the new company does not cover any plastic surgery....so if I can get the procedure done now and paid for...all the better. But I am worried about the "medically necessary" part.

[Bsides 0]

oh wow, your insurance covers a Tummy Tuck? can I ask what insurance you have?

I was banded in February and have lost around 85 pounds. I really feel like I need one, but when I see people who have really saggy skin I feel like I'm just being insecure and should be happy with how It looks.

My skin is not so bad because i have worked out obsessively since having the surgery, however my stomach still looks ruined. I would also really like to know what medically necessary means.

[pongomp 1]

My insurance is Cigna. Congrats on your 85 pounds dude!

[notimetowaist 0]

Hi,

I work for an insurance company and medically necessary means there has to be a health reason for the procedure, not just cosmetic.

For example getting rashes or other skin irratations that won't go away or keep coming back.

Hope that helps

Sue

[mrskrzyz 1]

After losing 60 lbs. and not even a full year out... BlueCross Blue Shield approved me as medically necessary!!! I was stunned!!

I went for the consult... just for the hell of it... and my doc marked my reason as rashes. Never had to prove it or anything... first try, approved!!!!!

Scheduled in February and still can't believe it!!!

[pongomp 1]

Congrats! I have my consultation tomorrow, so we'll see how it goes.

[notimetowaist 0]

Congrats!! When my time comes I hope it goes that easy for me!