How to Convince Insurance Company to Cover Tummy Tuck?

Thanks much for a reaching out.   Having your insurance company pay for your tummy tuck can be a very difficult endeavor.   One of the biggest things they consider a medical reason is recurrent skin rashes under the skin fold that hangs. They usually like this to have failed conservative treatment which includes creams and the like. Usually you would have to have seen a dermatologist for six months without any improvement for them to cover surgery.  I hope this helps :-) 

Many years ago insurance companies would sometimes cover tummy tucks. This is no longer the case. Unfortnately patients are led to believe this can happen by uninformed primary care docs or other mis-informed people. Tummy tucks are performed in order to improve the appearance of the abdomen by removing skin and tightening the muscles. Insurance companies only cover "medically necessary" procedures. Rarely, mostly after massive weight loss, there can be a heavy redundant lower abdominal fold, or pannus. If this pannus is causing probblems such as chronic skin breakdown or infection that remains resistant to maximal medical therapy, a panniculectomy can be performed that is sometimes covered by insurance plans. However, this should not be confused as giving you the same result as a tummy tuck. The panniculectomy involves only the removal of the lower fold. 

A tummy tuck (abdominoplasty) is a cosmetic surgery, so it is NOT covered by insurance. This should not be confused with a panniculectomy, that can be covered under certain conditions set by your insurance company. The two procedures are very different!
 A tummy tuck involves skin undermining and tightening all the way up to the rib cage, "repositioning" of the umbilicus, tightening of the abdominal wall muscles, and is frequently combined with liposuction of the upper abdomen and flanks for better contouring. It is a wonderful aesthetic operation, with amazing results.
A panniculectomy only involves removal of overhanging skin (apron) in the lower abdomen, which is about half the extent of skin removed in a typical tummy tuck. No surgery is done around or above the umbilicus, no muscle repair or tightening is done, and no contouring with lipo is involved. Therefore, it is NOT an aesthetic operation, but rather a surgery done to improve hygiene in the lower abdomen and supra-pubic area. Insurance companies have different criteria for approval of panniculectomy, but they usually require documentation of severe, recurrent rashes or skin infections not responsive to medications and topical agents. They also require photographs and medical records from all treating physicians as part of the pre-authorization process. When our patients meet the insurance criteria for panniculectomy, we help them get pre-authorization to cover that part only. This will offset some of the costs of the full tummy tuck or abdominoplasty surgery.
I recommend that you consult with Board certified plastic surgeon(s) experienced in this type of surgery, where you can discuss your goals and expectations and find out if your insurance will cover any component of the tummy tuck. Best wishes!

Thank you for your question.  In general, a full tummy tuck is considered a cosmetic procedure and is not covered by insurance.  If someone had bariatric surgery and has a hanging flap of skin causing irritation, infection, and ulcers, the removal of only the overhanging portion may potentially be covered. All the best 

A  tummy tuck is considered a cosmetic procedure and in general  is not covered by insurance.  There are similar procedures such as a panniculectomy (removing some of the low hanging skin) that are covered but do not have the same cosmetic result.  Find a good PS that does a lot of tummy tucks and with their help you may be able to find the best way to finance a nice tummy tuck.Good luck,Jeremiah Redstone MD

That is a very good question. Every country has different rules and regulations when it comes to insurance. Unfortunately, a tummy tuck is not covered by insurance in the US. In other places like Brazil, insurance covers some TTs when performed in teaching hospitals. 
A panniculectomy is covered. The problem is that this essentially only part of a TT, it will only get rid of the excess skin in the lower abdomen and it will not correct muscle separation. This should help with the pain and make exercising easier though. So if you want the procedure to be covered by insurance a Panniculectomy is your best option.
Sorry, hope this helps,
Dr. Miguel Mota 

Thank you for your question. Insurance will not cover procedures that are considered cosmetic. However, when patients have had massive weight loss and the excess skin hangs below the pubic bone, insurance may cover a procedure known as a Panniculectomy. The patient must have clinical documentation of rashes as well as a letter of medical necessity from a referring provider. Photos must be provided to the insurance company as well. I would recommend speaking with your bariatric surgeon to see if they work with Plastic Surgeons in the area. We work with many post bariatric patients so it shouldn't be difficult to find someone. Best of Luck to you!

If you have documented symptoms from excess skin and abdominal tissue (pain, rashes, infection, etc.) it may be possible to have a portion or all of your expenses for a tummy tuck covered by health insurance. This depends a lot on your specific health insurance plan however. Most will look to see how far the excess skin hangs down past your pubic area. Typically your plastic surgeon will submit photos and a letter of medical necessity to the insurance company. The insurance company will then evaluate your whole clinical story and determine if the tummy tuck is functional or cosmetic.I hope this helps clarify things for you.Best wishes,Dr.Bruno

Tummy tuck, often done with liposuction of flanks, back and elsewhere, is usually not covered or helped by insurance company, unless there are functional issues associated with it, such as extreme weight loss and hygiene/rash issues after weight-loss surgery, scars and abdominal or umbilical hernias that can be corrected at the same time. The costs are usually minimized by attention to details in order to avoid subsequent healing issues. 

Unfortunately, a tummy tuck is considered cosmetic. This involves removing the excess skin and fat and moving the belly button and tightening the muscle. If you were to only have the excess skin and fat removed, this would be a panniculectomy. Insurance may cover this procedure but there needs to be documentation of massive weight loss (by surgery or natural methods) and rashes/infections of the area. Please see a board certified plastic surgeon in your area to discuss options and expectations. Good Luck!

Thank you for your question! Unfortunately, most cosmetic surgeons do not accept insurance to cover the cost for surgery. However, I recommend contacting your insurance company to find out what physicians are in your network and your specific policy guidelines to find out what can be covered under insurance. Best of luck!