I want a Tummy Tuck because where the fat hangs, I'm always taking care of rashes and small cuts. This is very painful and I need help to tuck the stomach area. Will insurance pay for this?
Will Insurace Cover Tummy Tuck to Fix Painful Rashes?
Doctor Answers (11)
Will insurace coverage for Tummy Tuck or Panniculectomy for painful rashes
Insurance do not pay for cosmetic surgery, An Abdominoplasty is a cosmetic procedure and the vast number of insurance companies will NOT knowingly pay for it .
An operation they MAY pay for is a PANNICULECTOMY (CPT 15831), the isolated cutting off of the Tummy overhang. Period. A relatively short procedure with no undermining of the skin to the rib cage edges. No removal of skin excess above the transverse tummy fold with relocation of the belly button. No muscle repair.
While a panniculectomy removes the overhang, it will NOT give you a flat tummy but the rashes should resolve.
Hope this was helpful.
Medical documentation required for consideration
Having reviewed cases for insurance carriers, and being familiar with their criteria, most insurance companies require that the rash has been documented by a physician for at least six months and has not been improved with nonsurgical treatment. By that I mean, topical antibiotic powders and creams, oral antibiotics and what they consider "conservative therapy". If your case meets that criteria, then they may authorize a panniculectomy, which is just removing the overhang of skin and fat that hides the area of the rash. They will not cover the traditional abdominoplasty, which requires elevating the skin and fatty tissue off the underlying muscle layer, tightening the muscles in the midline from the breast bone to the pubic bone, repositioning the bellybutton.
If you have a large pannus or hanging tissue, it may be possible for your insurance to pay for removal of the fat. This is not an abdominoplasty but a panniculectomy and does not involve tightening the muscles and may involve removal of the belly button. Insurance will not pay for a standard abdominoplasty.
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Tummy tuck and panniculectomy.
Here's a summary for you. You would benefit by both a tummy tuck and a panniculectomy which of course are done together. The tummy tuck makes your whole stomach look better, it is cosmetic, and it is not covered by insurance. The panniculectomy cuts out the hanging apron of skin and fat, it is medically indicated, and it can be covered by insurance, but you must get pre-approval from the insurance company.
If you get insurance approval for the panniculectomy and you do both, then you would have to pay for the tummy tuck part yourself. Or you can just do the panniculectomy, which deals with what bothers you most anyway.
Tummy tuck vs panniculectomy
A tummy tuck is a cosmetic procedure to remove excess skin and repair the stretched out anterior abdominal wall muscles. I personally also do liposuction of the upper abdomen, flanks, hips, upper buttocks and back to achieve the best shape. A panniculectomy is done to get rid of the excess skin overhang and stop skin rubbing on skin which results in the medical problems you are experiencing. This might be covered by your insurance. If that is what you are interested in, I would refer you to a general surgeon. I do not do panniculectomies in my practice, they do not look pleasing, but will solve your skin issues. You do not state your height and weight, other medical problems you might have and it is possible that you are not a candidate for a tummy tuck.
web reference: www.bellevueplasticsurgeons.com
Tummy tucks covered by insurance
It is rare to see an insurance company cover a tummy tuck for any reason. You can always try though. It sounds like you would benefit from one but don't be surprised if the insurance won't get involved. As soon as they hear the words "tummy tuck" they turn and run!
Insurance for Tummy Tuck
Occasionally, insurance covers excision of excess skin when rashes occur under the overhang of tissue. Documentation by a family doctor over a period of a year is usually necessary. Various treatments also need to be documented. I have seen patients who have undergone gastric bypass and their abdominal lipectomy is covered for similar reasons. Most of the time, it depends on the insurance company.
Tummy tucks can be covered by insurance in some cases
It really depends on your specific case and your insurance, so I would recommend having an exam and seeing what your plastic surgeon thinks. Some insurance carriers are stricter than others, and they may want photos, etc. before they will agree to pay for it.
Insurance coverage for tummy tuck
In most cases, insurance will not cover a tummy tuck or abdominoplasty. This is the medical terminology for a cosmetic procedure. However, in some cases, insurance companies will cover a panniculectomy, which is similar to a tummy tuck but is done for medical reasons. In most cases, the reasons are massive weight loss, chronic sores, etc. This procedure typically just involves removing the excess skin, but does not involve tightening the muscles.
Insurance coverage for tummy tuck
In rare circumstances, including a documented history of rashes and wounds, an insurance company may cover a procedure called a panniculectomy. This is a wedge excision of overhanging skin. It's important to realize that this is a functional operation, not a cosmetic one, and the results are not comparable to a tummy. In a tummy tuck, the skin is removed and the muscle is tightened to try to obtain a flat, pleasing contour of the abdominal wall. In a panniculectomy, extra skin and fat is wedged off; nothing else.
Not all insurance companies cover this procedure - some have specific exclusion criteria. It's best to contact your insurance carrier to see if this is a covered benefit. If it is, start with your primary care physician to see if conservative management is effective in healing your wounds and cuts. If it is not, then your insurance carrier may consider paying for a panniculectomy. Again, though, do not expect results that are comparable to a tummy tuck.
Best of luck.