I have lost nearly 60 lbs, and have a Huge amount of abdominal skin hanging down. Makes my shoulders and back ache, have constant issues with yeast, which can be smelly as well as painful Will insurance consider this?
I Have Lost Nearly 60 Lbs, and Have a Very Large Amount of Skin Hanging Over, Would Insurance Help with This?
Doctor Answers (7)
Insurance coverage and lax abdominal skin
Insurance companies will not pay for any procedure deemed to be cosmetic in nature such as a tummy tuck. However, on occassion, they will cover a procedure known as a panniculectomy which is the resection of a large apron of skin of the lower abdomen and which is associated with local skin infection, severe rashes and/or skin breakdown.
In order to find out what is right for your situation, consult with one or more board certified plastic surgeons. It is also best to do what is right not just what insurance will pay for (if anything).
No insurance for a cosmetic tummy tuck but maybe another option
Thank you for your question. Insurance does not pay for a full tummy tuck but sometimes insurance will help pay for what is called a functional abdominal panniculectomy if you meet certain criteria. A panniculectomy only removes the hanging roll below the belly button. To see if a panniculectomy or a tummy tuck is right for you, see two or more board-certified plastic surgeons in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery. I hope this helps.
Panniculectomy insurance coverage
Some insurance companies (but very few) will pay for panniculectomy, which is removal of the hanging skin apron of the abdomen. Generally, it has to be established that comprehensive dermatologic treatment has failed. Although this may not be the "best" operation for you, if you have looseness of the abdominal musculature, if you cannot afford a tummy tuck and your issue is the inability to control the skin infections, then it is worth pursuing.
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Even if insurance covers, you don't want the operation they pay for!
Congratulations on your weight loss! Unfortunately, insurance only covers surgery that restores function or treats medical/surgical disease. Shoulder and back ache, as well as yeast infections, may in some cases (chronic problems documented in your medical record and for which maximum non-surgical treatments have been unsucessfully tried) qualify for insurance reimbursement . . .
. . . BUT, only for panniculectomy, NOT tummy tuck, extended tummy tuck, or lower body lift! Panniculectomy involves removal of only the single roll of excess skin that causes the rash and yeast infections (nothing else, so all of the remaining excess hanging skin still remains), and panniculectomy can still be a fairly "big" operation with some potential for difficult healing. And when everything is done and healed, you still have a "Huge amount of abdominal skin hanging down." So then you end up needing the tummy tuck, extended tummy tuck, or lower body lift you really needed in the first place! At your own cost, and another time off work, and another recovery, and another set of (minimal, but present) risks.
So why not just have the one operation you really need and would benefit most from, and forego the "free" unnecessary operation? Insurance will NOT cover the operation(s) you would get the best result from, and you have to pay for it anyway, so go through only one operation, one recovery, and one set of risks! Best wishes!
Abdominal Wall Contouring Surgery and Insurance?
Congratulations on your significant weight loss.
It is very unlikely that insurance companies will consider covering tummy tuck surgery. On the other hand, some insurance companies may cover panniculectomy surgery. I would suggest in-person consultation with well experienced board-certified plastic surgeons to discuss your goals, the best operation to help you achieve your goals, and whether or not that operation will potentially be covered by health insurance.
Treatment of excess hanging after weight loss
Insurance companies only cover "medically necessary" procedures. Some insurance plans may (emphasis on the work "may") cover a procedure called a "panniculectomy" which is essentially an amputation of excess skin below the waist level. However, this is NOT a tummy tuck. A tummy tuck, also known as an abdominoplasty, is usually the procedure that is needed for comprehensive anterior abdominal wall contouring. Tummy Tucks are deemed cosmetic and not covered by insurance plans. Please visit with a American Society of Plastic Surgeons member surgeon to learn more about your options.
Insurance "Coverage" of Hanging Skin Removal after Massive Weight Loss
Reconstructive Plastic Surgery refers to operations done to save lives and mprove function while Cosmetic Surgery refers to operations done to improve appearance. Each healthcare policy is different. The overwhelming majority of medical nsurance policies do NOT pay for Cosmetic surgery.
When it comes to hanging tummy skin, removing the skin apron or panniculus, may be paid for by SOME policies but it is far from being a Tummy Tuck. Unlike a Tummy Tuck this operation will not make you flat, will not flatten the tummy or narrow the waist nor I'll it lift a sagging Mons pubis, it will just remove the hanging skn to impove personal hygiene.