Does Aetna cover abdominal lipectomy?
Aetna considers abdominal lipectomy for the treatment of metabolic syndrome, or as an adjunctive procedure to assist with long-term weight loss following bariatric surgery, experimental and investigational because of insufficient evidence of its effectiveness.
Does Aetna cover cosmetic surgery?
Aetna plans exclude coverage of cosmetic surgery and procedures that are not medically necessary, but generally provide coverage when the surgery or procedure is needed to improve the functioning of a body part or otherwise medically necessary even if the surgery or procedure also improves or changes the appearance of a portion of the body.
Does Aetna Insurance cover hernia repair?
Aetna considers repair of a true incisional or ventral hernia medically necessary. Aetna considers repair of a diastasis recti, defined as a thinning out of the anterior abdominal wall fascia, not medically necessary because, according to the clinical literature, it does not represent a "true" hernia and is of no clinical significance.
Does Aetna cover lap band and tummy tuck?
I had a pretty easy time with Aetna covering my lap band, however, a Tummy Tuck is not so easy. They only cover a panniculectomy, not a tummy tuck and even with that, you have to have documentation of rashes, treatment, etc. Your pannus also has to hang to a certain level below your pubis.
Is abdominoplasty ever covered by insurance?
In many cases, a tummy tuck is merely a cosmetic procedure, and most insurance plans will not cover this. However, if you are experiencing rashes or skin infections, it then becomes a medical need to have the surgery. In this case, you may be able to get some of the costs of your tummy tuck covered by insurance.
Can a tummy tuck be medically necessary?
A panniculectomy differs from other tummy tuck methods in that the abdominal muscles are typically not tightened. It is more of a corrective surgical procedure, often needed as a medical necessity, to improve a patient's quality of life.
Do I qualify for a Panniculectomy?
You may be a candidate for a panniculectomy if you: have recently lost a large amount of weight and have loose belly skin that you want to remove. are experiencing hygiene issues from excess skin hanging below the pubic region. keep getting ulcers, infections, and other related issues under the hanging skin.
What is the difference between a tummy tuck and a Panniculectomy?
A tummy tuck tightens the abdominal muscles and removes excess fat, skin, and tissue, while a panniculectomy is performed to remove a pannus. The pannus is a large flap of skin which is distended over the abdomen, genitals, and thighs following significant weight loss or complications from childbirth.
What does your BMI have to be for a Panniculectomy?
Reaches a body mass index (BMI) less than or equal to 30 kg/m2; or. Has documented at least a 100 pound weight loss; or. Has achieved a weight loss which is 40% or greater of the excess body weight that was present prior to the individual's weight loss program or surgical intervention.
What is the difference between abdominoplasty and tummy tuck?
During a tummy tuck, excess skin and fat are removed from the abdomen. The skin is then draped back over the newly repositioned contours to create a smoother and more toned look. A tummy tuck — also known as abdominoplasty — is a cosmetic surgical procedure to improve the shape and appearance of the abdomen.
How long does it take to get approved for a Panniculectomy?
information from your visit is sent to your insurance company for authorization. This process can take from 14-60 days. medical information, your insurance company will make the decision about whether to cover your panniculectomy.
Will my stomach be flat after a Panniculectomy?
After the procedure, you can expect your low abdomen to look flatter and smoother. Most people also notice a new boost in their self-esteem after their panniculectomy because they feel more positive about their appearance.
Why is a Panniculectomy medically necessary?
Panniculectomy surgery may be indicated to reduce the panniculus. The surgery removes the excess skin and fat that hangs over the abdominal area. It may be indicated if the panniculus interferes with a person's daily activities (ADLs) and/or results in severe skin conditions that do not resolve after medical treatment.
How do I get insurance to cover a Panniculectomy?
In many cases, panniculectomy surgery is covered by insurance. In order to qualify, insurance companies often require documentation from medical providers relating to weight loss and/or weight loss surgery, irriatation of the skin or other problems that affect everyday life.
Is abdominoplasty a major surgery?
A tummy tuck is a major surgical procedure that will require weeks to heal. The technique includes an incision, running from hip to hip. Patients should expect their recovery to take two to three weeks.
What is the average cost of a Panniculectomy?
A panniculectomy is more expensive than a tummy tuck, but it's often covered by medical insurance. The cost can range from $8,000 to $15,000, plus anesthesia and other extras. A tummy tuck is less expensive but is not covered by insurance. This elective procedure costs on average around $6,200.
Why is rhinophyma excision considered cosmetic?
Excision or shaving of rhinophyma is considered cosmetic when the afore-mentioned criteria are not met.
What is DCA injection?
Sykes and associates (2017) noted that deoxycholic acid (DCA; Kybella, Allergan Pharmaceuticals, Irvine, CA) is a novel injectable treatment used for the cosmetic reduction of redundant submental fat. By inducing adipose cell lysis, the soft tissue alteration induces subsequent contour change and sharpening of the cervico-mental angle. The safety and efficacy have been well established in several prospective clinical trials and subsequent FDA approval for this purpose. This has provided an effective and less invasive alternative to surgical liposuction with virtually no recovery time and less overall discomfort. Given its success for use in this context, a logical step would be to extrapolate to other regions of the body where cosmetic deformity is caused by excessive adipose tissue. In this study, the authors proposed potential options for further use in various targeted areas where subcutaneous fat may be amenable to reduction with DCA injection, understanding that such uses would be off-label and require an understanding of the regional anatomy and possible complications.
Is otoplasty considered cosmetic surgery?
Otoplasty to correct large or protruding ears is considered cosmetic when the surgery will not improve hearing. Panniculectomy: Considered medically necessary when criteria are met, as set forth in CPB 0211 - Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair.
Is lipoma excision considered medically necessary?
Lipomas: Excision is considered medically necessary if lipomas are tender and inhibit the member's ability to perform daily activities due to the lipomas' location on body parts that are subject to regular touch or pressure.
Is hair transplant considered cosmetic?
Hair transplants performed to correct male pattern baldness or age-related hair thinning in women are considered cosmetic. Testicular prostheses: Considered medically necessary for replacement of congenitally absent testes, or testes lost due to disease, injury, or surgery.
Does Aetna cover prosthetics?
Note: Most Aet na plans cover prosthetic devices that temporarily or permanently replace all or part of an external body part that is lost or impaired as a result of disease, injury or congenital defect. The surgical implantation or attachment of covered prosthetics is covered, regardless of whether the covered prosthetic is functional (i.e., regardless of whether the prosthetic improves or restores a bodily function). The following surgical implantations are covered when medical necessity criteria for the prosthetic device are met, even though the prosthetic device does not correct a functional deficit.
Is breast augmentation considered cosmetic surgery?
Additionally, many Aetna plans specify that certain procedures are not considered to be cosmetic surgery (e.g., surgery to correct the result of injury, post-mastectomy breast reconstruction, breast augmentation to treat gender dysphoria, surgery needed to treat certain congenital defects such as cleft lip or cleft palate).
What procedures are not covered by Aetna?
The following procedures are not covered by Aetna: Bariatric surgery as a treatment for idiopathic intracranial hypertension. Gastroplasty, more commonly known as “stomach stapling” (see below for clarification from vertical band gastroplasty) Intragastric balloon. Laparoscopic gastric plication.
Does Aetna cover weight loss surgery?
Aetna covers most weight loss surgeries. However, you should note that most Aetna HMO and QPOS plans exclude coverage of surgical operations for the treatment of obesity unless approved by Aetna. Make sure you contact Aetna directly to find out if you policy includes weight loss surgery coverage.
What to do if you have a tummy tuck?
If there is some type of health problem that can be linked to the need to have a tummy tuck, your health insurance company may be willing to provide some coverage . Determine whether your abdominal region is causing you ...
Does insurance cover breast reduction?
Health insurance companies often cover the cost of breast reduction due to back pain, so it’s not unheard of that some will provide coverage for tummy tucks when the stomach causes this same problem. Allow your doctor to check you for a ventral or umbilical hernia.
Can you get a tummy tuck with insurance?
These are both problems that can be caused by the abdominal region. Health insurance companies may provide coverage for a tummy tuck for patients who experience either of these health problems due to their abdomen. Have your doctor put you on a diet and exercise regimen ...
