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How can i get my insurance to understand that i need a Tummy Tuck?

It's making my back pain worse. Well 24 yrs ago had a emergency c-section and i got staff from it and they sent me home with a gaping hole that i had to take care of by myself. then i had a hysterectomy that didn't go well and i had lap band surgery and got staff again in and out,then had a gastric sleeve and have gone from a size 22 to a 14 ,before this hangover thing i didn't have pain like this and i don't want to nor can i take any more steroids i have had enough of them.and i am so tired of pain meds.and being in 24/7 pain

Doctor Answers (6)

Insurance and tummy tuck, not likely

+2
If you have a lot of skin hanging over your panty line, with skin rashes or sores in the folds, which don't respond to medical treatment, your surgeon might be able to convince your insurance to cover a portion of the procedure, the skin removal part (panniculectomy). However, the muscle tightening is not likely to be covered. In addition, this is not likely to remove enough skin (weight) to make much of a difference in the pain of your back pain.

If you have been on steroids recently, your risk of complications is higher than I'd feel comfortable with. You 'd have to be off them for some time (I prefer at least a year), non-smoking (100%), healthy (diabetes must be tightly controlled, and no other major issues) and no longer obese for me to feel comfortable operating.


Chapel Hill Plastic Surgeon
5.0 out of 5 stars 6 reviews

Panniculectomy is not the same as a tummy tuck

+1
Insurance carriers vary on criteria they use to determine if a patient is covered for excess skin.  They typically will cover a hernia or skin excess that has failed conservative management and meets their criteria.  Typically recurrent documented infections failing treatment, excess skin hanging a certain distance below the pubic bone, limitations of activity of clothing and documentation by your primary doctor is key.  Even with all of this some carriers will still deny coverage.  Panniculectomy involves removing skin only, usually half the distance from the umbilicus and pubic bone, and does little to cosmetically contour the abdomen like a tummy tuck (which involves elevating the skin to the rib cage, leaving belly button attached to muscles, tightening the muscles and removing ALL the skin below the belly button).  The reason insurance is making it more difficult for those that need panniculectomy is because the system has been abused in the past and they were paying for cosmetic procedures.  The pendulum has swung the opposite way.

Insurance coverage of post weight loss, post lap band surgery abdominal skin excess.

+1
Greetings,

Probably the simplest course of action for you would be a return to your lap band surgeon to obtain a supporting letter for the insurance company.  

This can be followed with a referral to a plastic surgeon known to your bariatric surgeon for panniculectomy and associated necessary procedures....

Best Regards,

Douglas J. Raskin, MD, DMD
Colorado Springs Plastic Surgeon
5.0 out of 5 stars 26 reviews

Insurance is unlikely to pay for an abdominoplasty

+1
An abdominoplasty Is an aesthetic procedure and is almost never covered by insurance. Fascial defects such as umbilical hernias might be covered if they exist and are repaired at the time of an abdominoplasty.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 8 reviews

How can i get my insurance to understand that i need a Tummy Tuck?

+1
Insurance will not cover a tummy tuck.

Find a board certified plastic surgeon who performs hundreds of tummy tucks and body contouring procedures each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD

Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 218 reviews

Insurance Does Not Typically Pay for Tummy Tuck

+1
There are many reasons that a Tummy Tuck is not covered by most insurance plans. Some will, however, cover a panniculectomy. A panniculectomy is far less powerful a tool for improving cosmesis but can be helpful for functional problems.
Best,
Dr. Pyle

Jeremy Pyle, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 23 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.