Tummy tuck and insurance

Hi, the only thing that insurance companies will cover is a panniculectomy, which is removal of the overhanging skin.  Most companies will ask for documentation that you have seen a dermatologist for recurring rashes between the skin folds, and that you have undergone a significant weight loss which produced that excess skin.  They will not cover tightening of the muscles which is done with a cosmetic abdominoplasty. It is fraudulent for a physician to bill an insurance company for a cosmetic procedure.  Good luck, /nsn.

Despite the fact that you could certainly have physical benefits from this surgery, such as reduced back pain, insurance companies consider this a cosmetic procedure.  It is very unlikely you will get them to cover it.  We see this all the time with our patients who have undergone weight loss, either on their own or after operations such as gastric bypass.  If you have rashes in the skin folds that do not respond to medical therapy, this may sometimes convince the insurance company to cover the procedure but this is rare.  If you want to pursue it, I suggest getting letters from orthopedic surgeons, neurologists and chiropractors that support the claim that the back pain is from the weight of the excessive abdominal skin and/or rectus diastasis.  You can submit these letters to your insurance company.  You can also see if there is an insurance specialist in your area who can help you deal with the insurance company.  It is possible your local plastic surgeon would know someone who does this. This would obviously cost you some money.  Hope this helps.  There are many patients in the same situation across the country. 

Tracy M. Pfeifer, MD, MS

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