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.
Congratulations on your weight loss. Based on your photographs, you seem to be a good candidate for tummy tuck surgery. Unless there is some unusual circumstance, insurance companies generally do not cover tummy tuck surgery. In other words, insurance companies do not consider this operation medically necessary. Sometimes, however insurance companies will cover excision of lower abdominal wall skin/apron; this operation is called a panniculectomy. Best wishes.
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.
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....
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.
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
website before and after photo galleries to get a sense of who can
deliver the results.
Kenneth Hughes, MD
Los Angeles, CA
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.