Question about getting Tummy tuck covered - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

LoriAnn925 · 06-15-2009, 09:52 AM

Ok - I am thinking about trying to get a tummy tuck covered by my insurance. I have looked up what Cigna covers and their requirements, but have a question that I hope someone here can help me with.

Here is what Cigna says in their Medical Coverage Policy:

Cigna covers panniculectomy, with or without abdominoplasty, as medically necessary when BOTH of the following conditions are met as demonstrated on preoperative photographs:
• Pannus hangs at or below the level of the symphysis pubis
• Pannus causes a chronic and persistent skin condition (e.g., intertriginous dermatitis, panniculitis, cellulitis or skin ulcerations) that is refractory to at least six months of medical treatment. In addition to good hygiene practices, treatment should include topical antifungals, topical and/or systemic corticosteroids, and/or local or systemic antibiotics.

So, exactly how far down does the pannus have to hang to be "at or below the level of the Symphysis pubis"? I looked up the symphysis pubis and know anatomically where it is on a skeleton - but in terms of hanging skin - what do you think we're talking about?

Also, for this chronic persistent skin condition, I'm assuming that the rash I get under my pannus when I'm hot and sweaty, will suffice for this. I just have to start going to the doctors for it, preferably after a hard weekend of working out or yard work.

Thanks in advance for your help.

Lori

poet_kelly · 06-15-2009, 10:00 AM

Go to the doctor for the rash. You'll probably have to go several times. You'll need to show that whatever treatment your doctor prescribes doesn't do the trick. You might also want to take pictures of the rash.

I'm not sure exactly where the symphysis pubis is. I would ask the doctor when you go about your rash.

Kelly

Kimberly76 · 06-15-2009, 10:05 AM

My insurance reads.. a weighloss of 100 lbs , atleast 6 months out from surgery, and being deemed medically necessary.

If other parts of me are not covered, but is deemed medically necessary, I'm planting a plot of poison ivy, and I'm gunna rub it under my arms, at my thighs, and at my boobs.. that's a rash, right? Being deemed medically necessary, oh the back aches from my low sagging boobs.

LoriAnn925 · 06-15-2009, 10:26 AM

Quote:

Originally Posted by Kimberly76

My insurance reads.. a weighloss of 100 lbs , atleast 6 months out from surgery, and being deemed medically necessary.

If other parts of me are not covered, but is deemed medically necessary, I'm planting a plot of poison ivy, and I'm gunna rub it under my arms, at my thighs, and at my boobs.. that's a rash, right? Being deemed medically necessary, oh the back aches from my low sagging boobs.

I hate to admit it, but I have considered something along the lines of posion ivy too. Maybe I need to start experimenting to see what things I'm allergic to, so I can "create" a rash. lol Cigna also requires you be 18 months out from surgery, but that's not an issue for me, since I'm 33 months out now.

Jaylenev · 06-15-2009, 11:16 AM

I'm not the only one who has been praying for a rash... LOL

LoriAnn925 · 06-15-2009, 11:37 AM

Quote:

Originally Posted by Jaylenev

I'm not the only one who has been praying for a rash... LOL

I think there are a few of us who are praying for a Rash. Although, since praying for ourselves seems selfish, maybe we should pray for each other instead. LOL

MiladyB · 06-15-2009, 09:42 PM

Lori Ann, your insurance requirements are pretty close to what mine was. My pannus had to hang down over my pubic area. In regards to the rash I had to have 6 months of monthly documentation with my pcp. They also wanted to see that my pcp ordered oral treatment and treatment with creams.

Good luck to you!

sherry7 · 06-15-2009, 09:55 PM

Quote:

Originally Posted by LoriAnn925

I think there are a few of us who are praying for a Rash. Although, since praying for ourselves seems selfish, maybe we should pray for each other instead. LOL

Ha ha! Just accidentally leave some soap suds there...that kills me every time.

poet_kelly · 06-16-2009, 01:11 AM

I tend to get a heat rash in the summer. Not just under my belly, but under my breasts, too. I've had that problem for years, since I've been very overweight. I wonder if it will continue now that I'm losing weight? I'm sure I'm going to want some loose skin removed, but I'm not done losing weight yet. I am worried about how I will pay for it, and hope I can get my insurance to cover it. I don't suppose there is any way to get them to cover a breast lift, is there?

Kelly

watfam4 · 06-16-2009, 06:43 AM

There is a bone you can feel in the pubic area (just above the business). This is the symphysis pubis.

I am in the same boat with the rash. I know that if am not cleaning and powdering that area twice a day, I'll get a rash. But having to allow it to happen just so I can document it annoys me. I guess that a few months of being uncomfortable is worth it. What a hassle.