Insurance Coverage for Body Lifts for Non-cosmetic Purpose?
- Asked by sarahb in Berlin, MD
- 4 years ago
Are Body lifts covered by insurance if sagging skin causes back pain, or you have skin tears due to sitting on the folds of skin, etc.?
Insurance covering Surgery after Massive Weight loss
Thank you for your question. It is a very good question and can really only be answered by your insurance company. I would suggest that you make a few phone calls to see what they say regarding covering such procedures and then see who is on their provider list.
Please make sure that the surgeon you see has experience with patients who have had significant weight loss.
Web reference: http://www.poustiplasticsurgery.com/weightloss.htm
Body lift and insurance coverage
A body lift is generally not covered by insurance as it is deemed cosmetic surgery. However, a panniculectomy (removal of an apron of excess skin hanging below the waist) may be covered if you have documentation of skin rashes, infections or other problems. Usually, insurance companies require medical documentation of these problems persisting for at least six months. You need to check with your insurance company to find out the details. So although a body lift is not covered by insurance, a panniculectomy may be covered in very specific situations. A body lift can be completed at the same time as a panniculectomy, but there will be additional cosmetic fees for the surgeon's time, Operating Room and anesthesia fees. Hope this helps.
Web reference: http://www.basuplasticsurgery.com
Insurance won't cover body lift surgery.
Some doctors will be happy to try for insurance coverage (that is how they have patients choose them rather than other surgeons who know that coverage is almost NEVER obtained). Of course, when coverage is denied, the patient tends to stay with that surgeon rather than researching those who truthfully stated initially that insurance does not cover body lift surgery. Everyone wants a bargain, but no one wants bargain basement results!
Some patients may obtain insurance coverage for treatment of chronic skin infections, and if a certain (large) amount of skin hangs over the pubic region. Each insurance company has different guidelines, and these must be met in order to obtain coverage. However, what is covered is panniculectomy, which is removal of the pannus, or overhanging suprapubic skin apron, only. The coverage usually amounts to several hundred dollars, plus the OR and anesthesia fees. Once you're done with this, you still need removal of the rest of the upper abdominal loose skin, tightening of the abdominal muscles, and removal of the thigh, hip, and buttock excess skin. In essence, you need the rest of a belt lift or body lift, and another much more expensive operation (and recovery) that is NOT covered. What I advise my patients is that they not get panniculectomy surgery (just because it's covered, and may be "free" or low cost); rather, avoid the "extra' risk and recovery, and have the operation that is actually required--this will be considered NOT covered anyway, and having had a previous panniculectomy can actually make a proper body lift or belt lift more difficult. Even if you have a hernia, repair will be covered (and may be needed if there are obstructive symptoms--consult your doctor), but will not cover the remainder of a body lift or circumferential belt lift. We're talking about less than $2000 "covered cost", compared to $17000 out-of-pocket cost. (This cost is what I charge for outpatient lower body lifts--total cost--in our accredited office surgical facility--my partner and I have done over 250 belt lifts or body lifts as outpatient procedures over the past 13 years.) Hospital procedures usually cost significantly more, and in my opinion, are not necessarily "safer."
BTW, loose or overhanging skin does not cause back pain, even if you can get your doctor or chiropractor to say that it does; the back pain more likely is a result of having been overweight initially. Losing the unneeded weight, whether by diet and exercise, or by lap band, gastric bypass, or other surgical means is the best thing any patient with back problems can do to help themselves!
Not that I have seen.
Insurance companies try pretty hard to not cover anything even remotely cosmetic. I have not seen one cover a lower body lift.
John Di Saia MD
Insurance for body lifts
While insurance will often cover the removal of skin because of chronic yeast infections and skin breakdowns it typically won't a complete body lift. I have seen no evidence that excess circumferential skin causes back pain.
Insurance coverage for body contouring.
Many PPO insurance plans will provide coverage for certain body contouring procedures. Usually a lower body lift is considered cosmetic in nature, at least to some extent. However, there are portions of the operation, such as panniculectomy or umbilical hernia repair, which would be covered by many insurance plans. Although this may not cover the entire cost for the full operation, it may decrease your out-of-pocket costs.
I have performed over 100 body lift and have not been able to get insurnace covergae even for one of them. You can however get insurance for a panniculectomy. This is excision of the pannus for medically necessary cases such as infection, ulcers, etc.
Does Insurance Cover Body Lift Procedures
Insurance may or may not cover your body lift procedure, depending on your provider and your plan. In some cases, typically after gastric bypass or other forms of massive weight loss insurance providers will cover portions of the procedure if you are experiencing skin rashes, infections or other medical problems due to the rubbing of excess skin. I would recommend first talking to your insurance provider to see what they are willing and able to cover. From there you will need to find a qualified body lift surgeon who is covered by your plan. The staff members at your plastic surgeon's office should help you with this process.
We Pursue Insurance Coverage for Our Patients
Since we are paid fby the insurance companies, we feel it is our responsibility to obtain approval from them.
If you have documented skin issues like infections or rashes, my office will help you collect the documentation and we will submit it to the insurance company for approval. Most plans have clear cut guideliens that if met, can provide you with some coverage.
We do not pursue insurance if you do not meet your plans criteria, as this is a significant amount of work for us.
Almost always, not
The situation for weight loss patients is unfortunately not ideal... Because there are documented benefits to losing weight from the perspective of your insurance carrier, it is in their best interests to pay for your weight loss surgery if you are overweight and at higher risk of developing medical problems down the road as a result of your weight. Once you have lost the weight, however, there is no benefit to the insurance company from having all of the excess skin that you have removed.
It is necessary to understand that insurance companies are "for-profit" entities, meaning that they are in business to make money. They only make money when they collect more in premiums from people like you than they pay out for services- so the goal is to take in a lot of money, and pay out as little as possible. With this in mind, we should not expect an insurer to care if you have loose skin- no matter how much you might have (I once even got a letter from an insurer saying that the patient should just use powder)...
You should be proud of your weight loss... but don't expect your insurer to help you achieve the body contour you want- that is going to be your responsibility. Many good financing options exist, and there are more surgeons trained in this discipline of plastic surgery than ever. Remember to find one certified by The American Board of Plastic Surgery.
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.