Will Insurance Cover a Panniculectomy Revision if Its Medically Necessary?

Question

I am having a Panniculectomy revision, I am just wondering if insurance companies cover revisions if my surgeon states that it is medically necessary?

Remus Repta, MD · Answer

Hello,

	If your insurance company covered your initial panniculectomy and you are having certain healing issues associated with it, the revision will likely be covered.  Your plastic surgeon will have to document how the revision is medically necessary including providing certain codes that identify what your problems currently are.

	All the best,

	Dr Repta

Tom J. Pousti, MD · Answer

Yes, if the initial surgery was covered by your insurance plan that is very likely that a 'medically necessary  revision&rdquo; will also be covered. Of course always best to check with the insurance plan directly.

	Best wishes.

Robert L. Kraft, MD, FACS · Answer

Your question hasn't explained the reason for revision and how this would be medically necessary.  If you have an open wound that requires closure or a postop infection, that would be covered. If it's to remove more tissue, which isn't causing an infectious condition, probably not.  The case should be precertified in writing such that everyone is on the same page as to financial responsibility.

Mary Lee Peters, MD (retired) · Answer

Most insurance policies are quite restrictive about covering plastic surgery in the Seattle area where I practise. Coverage of a panniculectomy does not guarantee coverage of a revision. It is important to get preauthorization from your insurance company to avoid unhappy finacial surprises afterwards. Good luck with the claims reviewer.

Alan M. Engler, MD, FACS (retired) · Answer

Maybe - but you have to check out your insurance before you proceed.

	In general, each insurance company (and policy) has to be looked at individually, and you cannot assume that any procedure such as this will  be "covered."  (Of course, in using the word "covered" you have to determine if what the insurance company authorizes or pays (two different things) will be accepted by your surgeon as full or partial payment.  If it sounds complicated, that's because it is...

	My advice:  visit a few plastic surgeons near you.  Explain your situation, what you want done, and how you would like it handled financially.  You'll need the help of whichever surgeon you use to find out how much, if any, of your procedure will be "covered" and, if so, how to proceed from there.  But finding a surgeon you're comfortable with needs to be the first step.

	I hope that this helps, and good luck,

	Dr. E

Will Insurance Cover a Panniculectomy Revision if Its Medically Necessary?

Answers (5)

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