Will Insurance Cover Excess Skin Removal if It's Causing Me Discomfort After Exercising?

I'm a 22 year old 6ft1 male, and 3 years ago I went from being 315lbs to 190lbs. Now I have a lot of loose skin on my arms, abdomen, pecs, butt, and thighs. I recently started to do sit ups for the first time, and after a few days of doing them the skin on my butt started to break causing a painful cut and bruise. I guess that when I sit down sometimes my cheeks get squished together and I suppose if its a hard surface the skin will break.

Doctor Answers (8)

Will Insurance Cover Excess Skin Removal

+1

By-in-large the insurers consider this skin removal after massive weight loss to be cosmetic and not "medically necessary."  Many policies specifically exclude skin reduction procedures, thereby not having to deal with considerations of medical necessity. 

That doesn't mean that it is not worth trying. 

You seem ready for an in person consultation. RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S.
Thank your for your question, best wishes.


Seattle Plastic Surgeon
4.5 out of 5 stars 30 reviews

Insurance coverage

+1

Unfortunately, insurance companies do not cover skin excision procedures for discomfort after working out.  My recommendation is that you visit with a board certified plastic surgeon in your area to learn more about your options.

Dr. Sugene Kim

Sugene Kim, MD
Houston Plastic Surgeon
4.5 out of 5 stars 36 reviews

Insurance companies

+1

I concur with my colleagues here.  It is extremely unlikely insurance companies will cover removal of your excess skin because they deem these procedures as not medically indicated and as purely cosmetic.  In addition, more and more insurance plans are now listing skin excision procedures on their list of "not covered benefits".  

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 114 reviews

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Excess Skin After Weight Loss

+1

Dear GrowingPain89,

For the most part, insurance companies are not going to cover the procedures you would be needing to address your concerns.  There are rare situations where a patient has significant medical problems due to the excess tissues, most commonly in the abdominal area from the apron of skin and tissue-called a pannus-that hangs down over the thighs.  This requires documentation that multiple other previous treatment efforts have failed and even then, many insurers will not cover the procedure.

Your first step is to consult with a board certified plastic surgeon who is familiar with management of the post-massive weight loss(PMWL) patient who after a consultation and an examination can best advise you on your course of action.  I know this is probably not the answer you wanted to hear but....it is best that you know what you are up against before you get started.  Best of luck.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.0 out of 5 stars 18 reviews

Loose skin and insurance

+1

Insurance does not cover loose skin excision after weight loss.  Sometimes they cover loose skin associated with severe rashes that are porperly documented and unamenable to conservative treatment.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Insurance coverage of excess skin removal

+1

If you want insurance coverage you will need medical record documentation of these problems. You need to see your GP for these complaints and have them generate a paper trail describing the tissue breakdown and attempted treatments that failed. Most insurance companies want documentation of skin breakdown and 3 to 6 months trials of non-surgical treatment even though once skin breakdown or rashes appear they never fully respond to non-surgical treatment.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Does insurance pay for excision of excess skin after weight loss?

+1
The standard I have seen applied by insurance companies is that the skin breakdown be refractory to dermatologic and antibiotic treatment of at least one year's duration. Induration and bruising alone will not suffice.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

No

+1

Almost all insurance companies consider this type of surgery to be cosmetic. Good luck in trying to get them to pay.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.0 out of 5 stars 9 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.