I have diastasis of the abdominal rectus muscle....opinions?

Question

I had my doctor send in a letter of predetermination to my Insurance Co stating that i have 2 inch gap in my upper abdominal rectus and a 4 inch gap below the navel & my decending aorta is exposed which can be felt easily, which could potantially kill me if i acidentally get kicked or rammed in he tummy the wrong way by playing children or a car seatbelt. The only kinda docs that will perfom this kinda surgery is a plastic surgeon. But HE said its not considered plastic surgery because is rather reconstructive due 3 pregnancys close together over stretched my abdominal wall causing it to separate. I do not want a tumy tuck..but the insurance company insists that its cosmetic and said they'd only repair my herniated belly button. I have two docs saying the same thing and i need to get the ab wall closed asap because they can easily feel my decending aorta. The insurance co still denys payment for this. should i appeal it or am I a o l? any suggestions r helpful.

Answer 1

You have to do what is best for you. Having the surgery is best for you.

Yes, you can appeal but it will take time and that is what the insurance companies depend upon. Most people will not fight their decisions, and again, that is what the insurance companies depend upon.

I would recommend filing the appeal and get the surgery done now. Losing your life is not worth waiting for bureaucratic red tape.

Worst case scenario, you pay $50.00 a month for a couple years until the hospital writes off your debt or the insurance company agrees to pay the tab. Either way, you get the surgery you need.

GOOD LUCK!