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How to Convince Insurance Company to Cover Tummy Tuck?

asked 2 years ago by Tech58 in South Dakota
Latest answer by Christine Sullivan, MD
Question viewed 5,276 times
Tags: abdomen, back, hips, excess, exercise, insurance, pain, skin

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.

12 answers to How to Convince Insurance Company to Cover Tummy Tuck?

+1

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
+1

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

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... more
Peter A. Aldea, MD

Memphis Plastic Surgeon
+1

Convincing insurance companies for tummy tuck coverage

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.
Darryl J. Blinski, MD

Miami Plastic Surgeon
+1

Your Insurance Company Will NEVER Pay for a Tummy Tuck

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 an more
Michael C. Pickart, MD

Ventura Plastic Surgeon
+1

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... more
Nina S. Naidu, MD

New York Plastic Surgeon
+1

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... more
Sam Jejurikar, MD

Dallas Plastic Surgeon
+1

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.
Barry E. DiBernardo, MD

Montclair Plastic Surgeon
+1

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... more
John P. Stratis, MD

Harrisburg Plastic Surgeon
+1

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

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... more
Francisco Canales, MD

Santa Rosa Plastic Surgeon
+1

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... more
Walter D. Gracia, MD

Arlington Plastic Surgeon
+1

Insurance coverage for abdominoplasty

Insurance companies have various criteria for deeming your condition severe enough and the surgery medically necessary. Obvious signs are frequent rashes requiring treatment, ulcerations of the skin, and infections (cellulitis) caused by open sores. It sounds as if this surgeon is not interested in doing the procedure recommended under an insurance plan. I would contact your insurance plan and check their criteria. Sometimes this is published on the internet. Consult with other plastic... more
Robin T.W. Yuan, MD

Beverly Hills Plastic Surgeon
+1

How can I get insurance company to cover tummy-tuck?

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... more
Tracy Pfeifer, MD

Manhattan Plastic Surgeon

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