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Covered Procedure or not?

by Polly1945

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Female, 63 years
Wichita - KS
Member since Jul 2008  

, Jul 22, 2008 12:15AM
I am scheduled for distasis recti repair surgery Aug 5th, 2008, and also for a ventral hernia surgery.
I have two surgeons involved of course, the plastic surgeon and the general surgeon that has done my previous surgeries
My problem is that I had been to my Gyn doctor who found cancer in the walls of my cervix three years ago, and he suggested that I see my surgeon reagarding my ct scan that showed diastasis recti on the scan and I didnt know what that was. I had mentioned to him that something was wrong, besides my abdomen being so swolen and getting worse, I have had bowel troubles (after doing everything possible) and also unrinary incontinence and voiding very little when I did go. This was all farirly new in the last year or so. My lower back hurt daily and I slept with a heating pad every night on my back to get relief
My gyn doctor informed me that I would need a plastic surgeon to do what is generally called a tummy tuck to repair the split miscles etc and I told him I couldnt afford to pay for a plastic surgeon
He informed me that in cases like this, where I had medical reasons for having it done and had medical problems that are related to having this surgery, then insurance should have no complications covering it as long as the doctor documents it correctly.

I saw both surgeons and they sent for approval with my insurance company only to be told that my hernia surgery was covered but my tummy tuck surgery would not be covered because it is considered cosmetic.
I didnt go into this for cosmetic reason at all and I took my last dime out of my father's inheritance to have this done so I could feel better, so I dont understand when insurance covers it and I need advice from someone as to what I need to do at this point
I have talked to the scheduling person and there is nothing that she can do to help me
When IS it covered ?
I had to pay $4000 today and the more I thought about it, the more upset I became
Help me someone to make me understand
I will follow through with this surgery for sure but feel I am being taken or something
I worked for this group of doctors for years and I trust them and just dont know if the coder is the one I need to talk to or what

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