Just had my 6 month follow up with my sleeve surgeon and he suggested i see his partner for a panni. Has anyone else had a doc do this so soon? I thought I would have to wait for at least a year

Aetna's policy:

Aetna considers panniculectomy/apronectomy medically necessary according to the following criteria:

1. Panniculus hangs below the level of the pubis; and
   
2. 
   The medical records document that the panniculus causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs over 3 months while receiving appropriate medical therapy (e.g., oral or topical prescription medication), or remains refractory to appropriate medical therapy over a period of 3 months.
   

Aetna considers repair of a true incisional or ventral hernia medically necessary.

1. 
   Aetna considers abdominoplasty, suction lipectomy, or lipoabdominoplasty cosmetic.
   
   

Background

In order to distinguish a ventral hernia repair from a purely cosmetic abdominoplasty, Aetna requires documentation of the size of the hernia, whether the ventral hernia is reducible, whether the hernia is accompanied by pain or other symptoms, the extent of diastasis (separation) of rectus abdominus muscles, whether there is a defect (as opposed to mere thinning) of the abdominal fascia, and office notes indicating the presence and size of the fascial defect.

Abdominoplasty, known more commonly as a "tummy tuck," is a surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure can improve cosmesis by reducing the protrusion of the abdomen. However, abdominoplasty is considered by Aetna to be cosmetic because it is not associated with functional improvements.

Aetna's policy:

Aetna considers panniculectomy/apronectomy medically necessary according to the following criteria:

1. Panniculus hangs below the level of the pubis; and
   
   
2. 
   The medical records document that the panniculus causes chronic intertrigo (dermatitis occurring on opposed surfaces of the skin, skin irritation, infection or chafing) that consistently recurs over 3 months while receiving appropriate medical therapy (e.g., oral or topical prescription medication), or remains refractory to appropriate medical therapy over a period of 3 months.
   

Aetna considers repair of a true incisional or ventral hernia medically necessary.

1. 
   Aetna considers abdominoplasty, suction lipectomy, or lipoabdominoplasty cosmetic.
   

Background

In order to distinguish a ventral hernia repair from a purely cosmetic abdominoplasty, Aetna requires documentation of the size of the hernia, whether the ventral hernia is reducible, whether the hernia is accompanied by pain or other symptoms, the extent of diastasis (separation) of rectus abdominus muscles, whether there is a defect (as opposed to mere thinning) of the abdominal fascia, and office notes indicating the presence and size of the fascial defect.

Abdominoplasty, known more commonly as a "tummy tuck," is a surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure can improve cosmesis by reducing the protrusion of the abdomen. However, abdominoplasty is considered by Aetna to be cosmetic because it is not associated with functional improvements.

Thank you for this information. I have Aetna and didn't think there was any chance of coverage but this is good to know. I definitely have a panni (still have another 60 pounds to lose) and have had a rash for YEARS now but it is more in my groin area. I wonder if that rash would be considered. It all started when I got so overweight so I know that the weight is/was a factor. Not that I really want to have another surgery but it is something I will consider when the time comes.

Sounds like he might be drumming up business then...

I AGREE. SOUNDS LIKE THE OTHER DOC MIGHT HAVE A CAR PAYMENT DUE. JUST WAIT OR YOU WILL HAVE TO HAVE IT DONE AGAIN.

Kaiser covers a tummy tuck, my dad lost weight a few years back using optifast and they completely paid for his tummy tuck.(a tummy tuck isn't the same as a panniculectomy)

I met with my surgeon the other day. He told me he would cut all the way around me. I think he tried to scare me out of it. I have to see the doc for 3 months in a row then everything gets sent to insurance and we see if i can get it.

For documentation does it have to be done by your doctor or can we do it?

It has to be done by the doc. But if u have skin breakdown or whatever in between appts you can take pics and and give them at your appts

I would like to have my panus removed now because it is so low and I am taking forever to lose weight.

Has anyone had this done in Mezico?

I have Kaiser and they DON'T convert a tummy tuck, only a panni removal. I am worried that a panni removal is going to look gross, but I guess it's no better than my current mangled belly. As far as I know a panni removal is just that,panni removal. They don't tighten any skin or do a belly button revision that you would get with a tummy tuck.

Be aware that different group plans, even if covered by the same carrier, may and do have different schedules of benefits. Just because two groups are covered under, say Blue Cross, does not mean that the two groups will have the same coverage. Each carrier, Blue Cross, Aetna, Humana, etc,. will have numerous plans, each of which will cover different things and/or will pay more/less on different procedures/treatments.

It does very little good to ask someone else who has the same carrier if and how it paid for this or that. Best thing to do is to call the number on your card and ask them.

I have Kaiser and they DON'T convert a tummy tuck' date=' only a panni removal. I am worried that a panni removal is going to look gross, but I guess it's no better than my current mangled belly. As far as I know a panni removal is just that,panni removal. They don't tighten any skin or do a belly button revision that you would get with a tummy tuck.[/quote']

Hi

Kaiser did convert my panni to a tt. I had to pay the difference but they did convert it. Not sure if its only through kaiser sunset but they do offer it there.

I just saw my surgeon this afternoon (Wed. Feb. 6) and she told me that Blue Cross will pay for removal of panni after one year from surgery date and a 100 pounds loss. Also' date=' if you have sores and irritated skin it needs to be documented with pictures for more proof that you need this surgery.[/quote']

Crooked are you in California? I've got anthem blue cross and had surgery march 6 2012 just got approved for initial plastics appointment. Is the 100 lost from surgery or from initial Bariatric process, I've only lost 92 from my largest when doc referred me to bariatrics but I've noticed that the pooch that was almost gone is now again folded over and the bat wings are awful create rashes and I've gotten a sore that left a scar. I hope Iim approved

I just called my health insurance (UHC) about this question. They said that TT, extended TT and panni are covered 100% if I meet the morbid obesity requirement as-of current health. This seems ridiculous!! Of course I am not going to meet that requirement now and I am pretty sure I would not be needing a Tummy Tuck when I was morbidly obese. Retrospectively, perhaps I should have submitted the claim for TT with the claim for VSG at the same time. They also said I can have my doctor submit a claim now with a solid reason to see if it is eligible according to UHC. Any idea what I can have my surgeon state as a reason to grease the eligibility as-of today when I am in healthy range according to the BMI chart?

Rashes and infections from where the skin rubs against itself

I have been maintaining now for 2 and a half years but have toned up (after falling pregnant 2 months post op of vsg) I struggle with the body i am left with and the fact that i didnt make it to my **goal** 132Lbs down and i seriously dont look the 205 that i stopped at many are supprised and so they would put me at no more than 165. wish i could be in this boat of getting it done myself! god knows i got more than my fair share of loose stuff!!! ha!!! i dont need a tt... i need a trade in!!!! arms boobs and tummy!!!!