I have had overlying skin on my lower abs since I was quite young due to the loss of weight. I then had two c-sections, hysterecotomy and the fat just increased. I now have lumbar lordosis, spinal stenosis and degenerative disc disease. Also asteoarthritis and fibromyalgia. Is a tummy tuck ever considered medical?
Is a Tummy Tuck Ever Considered Medical?
Doctor Answers (6)
Insurance coverage for abdominoplasty
Thanks for the question -
In our San Francisco practice we've done a fair number of abdominoplasties. It is unusual for companies to cover a true abdominoplasty.
Many insurers will cover massive weight loss patients for panniculectomies (removing the abdominal pannus). The theory here being that patients with skin down to their knees have significant mobility and hygiene problems.
We have had insurance companies cover abdominoplasty for significant abdominal scars but it is a rarity.
I hope this helps.
No, but it might help you very much
It sounds as though a tummy tuck might be very valuable and make your abdomen much better. The muscle tightening might help your back a little bit. You have enough anatomical problems in your back plus other conditions that you might not feel much different though. Don't expect that insurance will cover any of this.
Tummy tucks and insurance
A tummy tuck is almost never covered by insurance. Insurance companies sometimes cover a panniculectomy for massive weight loss patients.
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Tummy tucks are rarely considered medically necessary
Tummy tucks are a popular and effective way to recontour the abdomen. They may be commonly combined with other procedures that are considered medically necessary such as gynecologic surgery or hernia repairs. By themselves, however, tummy tucks are not medically necessary. If you have an excess amount of skin in your abdomen and our experiencing pain or rashes from this skin, you may benefit from a panniculectomy. This is an excision of the skin without a deeper muscle repair.
To learn more about tummy tucks, see photos, and help you decide which one is best for you, please visit us at the link below:
Web reference: http://www.miamiaesthetic.com/abdominoplasty_photos.htm
Medical necessity letter for Tummy Tuck
It is very hard to get insurance approval for an abdominoplasty. However, I would recommend that you try with your insurance company. Your letter to them must be supported with all the medical reports indicating the medical need for a tummy tuck.
Web reference: http://newportplastic.com/tummy-tuck/
Tummy Tuck and Insurance
There are many procedures that, while covered in the past, are no longer covered benefits under current insurance plans.
Scar revisions, skin rashes/ulcers/breakdown, may be covered under more generous plans but this is a rare event today.
Occasionally, associated hernias may be considered a covered procedure.
If you work for a large employer, you may carry more clout with your insurance carrier through your human resource department.
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