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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 (16)

Tummy Tucks and Insurance

+3

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

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 60 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.

Michael C. Pickart, MD
Ventura Plastic Surgeon
5.0 out of 5 stars 2 reviews

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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.

Nina S. Naidu, MD, FACS
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.

Sam Jejurikar, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 30 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.

Barry E. DiBernardo, MD
Montclair Plastic Surgeon
4.0 out of 5 stars 33 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.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 17 reviews

Tummy tuck or panniculectomy

+2

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.

Walter D. Gracia, MD
Arlington Plastic Surgeon
5.0 out of 5 stars 2 reviews

Tummy Tuck

+1
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 40 reviews

How to convince insurance company to cover tummy tuck?

+1
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 12 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.