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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 (13)

Tummy Tucks and Insurance

+2

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!

Columbus Plastic Surgeon
5.0 out of 5 stars 18 reviews

You can NEVER "Convince" an Insurance company to pay for Cosmetic Surgery

+2

Your surgeon, like all of us who were once idealistic when we completed our trainings, learned the hard way that insurance companies will try and often wiggle out of and delay paying for operations covered under their policies. They will NEVER pay for procedures that are not covered under their policies and that includes cosmetic surgery of which abdominoplasty is a part.

She did not "even try" (again) to "get the insurance company to do the surgery" because she is probably still recovering from old concussions resulting banging her head against the wall fighting similar battles in the past. It is a battle that is really not winnable.

Although SOME insurance companies MAY pay for weight loss / Bariatric surgery - I cannot think of a single one which pays for the cosmetic procedures you and other patients like you would greatly benefit from (Abdominoplasty, butt lift, thigh lift, breast lift and augmentation, Face and Neck lift). Although SOME MAY pay for a panniculectomy (tummy skin removal without muscle tightening and without belly button relocation) - they will never pay for a tummy tuck.

Dr. P. Aldea

Memphis Plastic Surgeon
5.0 out of 5 stars 52 reviews

Your Insurance Company Will NEVER Pay for a Tummy Tuck

+2

I think that you are confusing 2 separate procedures:

  • panniculectomy
  • abdominoplasty

A panniculectomy is a functional procedure for removing excess skin and fat. An insurance company MAY authorize a panniculectomy if...

  • The apron of excess abdominal skin impedes walking.
  • The apron of excess abdominal skin impedes normal groin hygiene.
  • There are recalcitrant fungal infections beneath the skin folds.
  • The infections have progressed to bacterial infections, necessitating hospitalization and IV antibiotics.

A panniculectomy is NOT an attractive operation. The goal is function, not cosmesis.

  • There is no tailoring of the skin excess.
  • There is no liposuction to contour the flanks.
  • The bellybutton is not preserved.
  • The muscles are not tightened.
  • The abdomen is not optimally flattened.

If your goals are functional, then you should consider a panniculectomy. Find a Board Certified Plastic Surgeon who accepts your insurance, and then speak with him/her frankly.

If, however, your goals are too have a more attractive torso, then you are looking for an abdominoplasty, better known as a tummy tuck. Obviously, no insurance company is going to pay for you to look cuter; that's your financial responsibility.

Ventura Plastic Surgeon
5.0 out of 5 stars 2 reviews

Tummy tuck and insurance

+2

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.

New York Plastic Surgeon
4.0 out of 5 stars 5 reviews

Abdominoplasty is not covered by insurance companies

+2

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.

Dallas Plastic Surgeon
5.0 out of 5 stars 23 reviews

Good luck on insurance coverage of Tummy Tuck

+2

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.

Montclair Plastic Surgeon
4.0 out of 5 stars 32 reviews

Insurance coverage for tummy tuck

+2

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.

Harrisburg Plastic Surgeon
3.5 out of 5 stars 8 reviews

Convincing insurance companies for tummy tuck coverage

+1

As the consensus shows the insurance companies do not offer cosmetic surgery coverage. If you have an abdominal hernia than part of the surgery can be covered. But you need a hernia general surgeon to evaluate and do an ultrasound or sonogram or MRI of the abdomen. This adds to your costs. Regards.

Miami Plastic Surgeon
4.5 out of 5 stars 56 reviews

We have not had an insurance company cover abdominoplasty in over 15 years.

+1

An abdominoplasty is an elective, cosmetic procedure, that is not generally in the covered benefits of any insurance company. There is no good correlation to hip pain and no certainty that any of these symptoms will improve. The insurance company is more likely to ask the patient to lose 25 pounds since that will also take care of a lot of the problems without having surgery.

In drastic cases of hanging skin/fat, there will be ulcerations and infection. In those rare cases (with photo proof of the ulcerations), the insurance company may allow removal of the lower portion of the hanging skin, but leave the upper abdomen/stretch marks/cosmetic aspects completely out.

Santa Rosa Plastic Surgeon
5.0 out of 5 stars 11 reviews

Tummy tuck or panniculectomy

+1

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.

Arlington Plastic Surgeon
5.0 out of 5 stars 2 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.