I had lap band surgery and now my belly is hanging down, making it harder to walk.
Will Insurance Cover Tummy Tuck when Belly Hinders Normal Walking?
Doctor Answers 7
Most insurance companies do not consider that a reason to cover the procedure. It is rare in fact for insurance companies to cover a tummy for any reason. Occasionally they will cover a panniculectomy if the patient has documented history of recurrent infections in the pannus.
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Insurance may cover Panniculectomy
Unless you surgeon lies to the insurance company, they will never pay for cosmetic surgery.
Depending on your policy, your insurance MAY pay for removal of the skin overhang. This operation is a PANNICULECTOMY NOT a Tummy Tuck (ABDOMINOPLASTY).
In an abdominoplasty not only is the overhang removed, we also remove MORE loose skin from the lower tummy, tighten the tummy muscles and relocate the belly button - in all, a much bigger operation.
I would suggest you check your insurance book and see if you have benefits for a panniculectomy. IF you do, then, look and see which plastic surgeons in your area work with your particular policy.
There are many variables, both physical, and insruance related to this answer. However I feel it is safe to say that insurance MAY cover a panniculectomy (removal of the skin/fat apron), but won't pay for the full tummy tuck, which also involves more extensive dissection and tightening of the muscles.
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Does insurance pay for a tummy tuck?
The answer is almost always 'no.' However, if you have a hernia as well then insurance will cover this and some of the costs for facility and anesthesia fees associated with the tummy tuck done simultaneously. If you're only looking for a panniculectomy, insurance may cover this, but you may need to have your plastic surgeon send in pictures and documentation for pre-authorization. The difference between a tummy tuck and panniculectomy is that in a tummy tuck the muscles are tightened and the belly button is re-positioned. Good luck!
Tummy Tuck Under Insurance
They will not cover cosmetic procedures as a tummy tuck is such. They may cover a panniculectomy. This is different from a tummy tuck because it only removes the excess skin and it does not have any undermining and muscle plication. Again this has to be a medically necessary procedure. If you have problems with infections or dermititis in the abdominal crease then it may be "medically necessary".
Tummy tuck and insurance
In general, no. Insurance companies only pay for "medically necessary surgery". Even though you may indeed have trouble walking, most insurance companies would not consider that to be a good enough reason to pay for the procedure (despite the protests of your plastic surgeon). In some cases, where the excess skin (we call it a pannus) hangs below the pubis such that you are left with chronic rashes that are not successfully treated by a dermatologist, insurance companies may actually pay. I find that approximately 10% of my weight-loss patients are able to sucessfully get pre-authorization for tummy tuck. The bottom line is that your pictures have to be very impressive and you also have to have documentation from a dermatologoist saying that your rashes will only be successfully treated by surgery. Hope this helps!
Insurance coverage for panniculectomy
If your insurance companies coveredyour lap band surgery, they might cover panniculectomy for the deformity that resulted from extreme weight loss. There are usually certain criteria that each plan looks for including ulcers, dermatitis, fungal infections, etc. They will also usually require a photo for a nurse or reviewer to exam.
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.