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How to Convince Insurance Company to Cover Tummy Tuck?

I went to see about a tummy tuck and the doctor said I was a good candidate to have it done. As soon as she heard of my insurance, she said no they do not cover that. With me having hip pain, back pain, unable to do many exercises from excess skin, how does a doctor let my insurance company know it is not just cosmetic. She did not even try to help me get my insurance company to do the surgery. I would like some help in this area.

Doctor Answers 18

Tummy tuck or panniculectomy

Based on the photo this is not a tummy tuck, The abdomin is very large and hangs down below the pubic area. Sometimes the insurance will pay for a panniculectomy. The panniculectomy is the removal of the excess skin that hangs below the pubic area and nothing more to get A nice looking taylored abdomin you would have to pay for the cosmetic part of the procedure otherwise you would still have an abdomin that you did not like. Even when the insurance company states that it is a covered procedure ( the Panniculectomy) the insurance company ends up not paying for it or taking numerous appeals and letters and months even years of time befor they make a final determination.

Most doctors do not want to and cannot afford to do a surgery that involved and then recieve $1100 as the entire payment and have the insurance company argue about it for such a long time. That is why the procedure was divided into a cosmetic part and a medically necessary part .

To summarize a panniculectomy only removers the skin hanging below the pubic area and the abdominoplasty is the part that makes it look good by tayloring the skin and relocating the umbilicus. The second part is cosmetic and payed by the patient.


Fort Worth Plastic Surgeon
4.5 out of 5 stars 3 reviews

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Tummy Tucks and Insurance

Tummy Tucks are typically not covered by insurance. I would suggest that you contact your Human Resources Department to advise you on your benefits. Best wishes!

Christine Sullivan, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 24 reviews

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.

Nina S. Naidu, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 6 reviews

Abdominoplasty is not covered by insurance companies

Hi,

Although most patients don't like it, abdominoplasty is considered a cosmetic surgery procedure and, as such, is not covered by insurance companies. The only operation that insurance companies will consider covering is a panniculectomy, in which a wedge resection of the lower abdominal skin is performed; the abdominal wall is not tightened, the skin is not lifted off the abdominal wall, and the belly button is not relocated. Insurance companies will usually only covering that procedure if patients have problems with skin breakdown, rashes, or difficulty walking due to the amount of the overhanging skin. It is no way a cosmetic procedure and the results are not comparable to abdominoplasty. If you have documentation of the above-mentioned problems, you may be a candidate for a panniculectomy.

Hope this helps. Best of luck.

Good luck on insurance coverage of Tummy Tuck

In general, the answer is NO. The only way you might have insurance coverage for tummy tuck is if you have constant rashes from the skin overlap and your dermatologist has tried for a long time unsuccessfully to treat it.

Insurance coverage for tummy tuck

Insurance companies do not cover tummy tucks, they are cosmetic. They do cover panniculectomy(removal of overhanging skin) when the patient meets the criteria. Each insurance company has their own criteria so you should talk to them first. They will also cover hernia repair but not the tightening of the muscles or repair of diastasis recti. Many plastic surgeons feel it is a waste of time and money for them to check with the insurance company but as the person who is covered by the insurance company you certainly should check.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 21 reviews

Insurance coverage for tummy tuck

Thank you for your question, and for posting your photo.  Insurance coverage can sometimes be obtained for panniculectomy - removal of the overhanging skin and fat - in certain circumstances.  Abdominoplasty (tummy tuck), in addition to removing excess skin and fat, includes tightening of the abdominal wall with deep sutures down the midline, as well as careful shaping of the belly button, and often some liposuction; panniculectomy includes only the removal of the skin and fat.  It is to the discretion of the plastic surgeon, and often at additional out-of-pocket cost, to perform a true tummy tuck rather than just a simple panniculectomy.  That said, insurance approval for panniculectomy usually requires documentation by a dermatologist of chronic, refractory skin problems beneath the overhanging abdomen, with good quality photographic evidence.  While it appears from the photo that you'd be a great candidate, it may require a plastic surgeon and a derm to go to bat for you with the insurance company.  Good luck to you.

Joshua D. Zuckerman, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 12 reviews

How to Convince Insurance Company to Cover Tummy Tuck?

I have never had an "insurance" entity authorize  tummy tuck surgery. In other words, insurance companies do not consider this operation medically necessary. Sometimes, however insurance companies will cover excision of lower abdominal wall skin/apron;  this operation is called a panniculectomy. Best wishes.

Tummy Tuck

Unfortunately, insurance companies do not cover aesthetic surgery. I have never known of an aesthetic tummy tuck being covered by insurance. 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 50 reviews

How to convince insurance company to cover tummy tuck?

Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation.  Often times a detailed description of your complaints as well as photos is mandatory.  It i also the surgeon's obligation not to attempt to get procedures purely cosmetic through insurance.  Given your photo, it does not appear that your abdominal panniculus would warrant insurance coverage and there is no literature evidence between panniculus with hip/back pain.

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you.  Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify.  Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 13 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.