Ask a doctor

What is the Best Way to Plead Tummy Tuck Case to Insurance?

I'm a mom of 2. After 2nd child I noticed that I had umbilical hernia. I got that repaired. In the Dr's summary he said "The abdominal wall was extremely thin around the hernia, and for this reason, the fascia was debrided in a longitudinal ellipse." 2 years later I start working out, abs especially, and another hernia has appeared! How disheartening! My Dr says that it's a hernia and gives a referral to a general surgeon. I don't want to get this repaired for it to only come back. Any Advice?

Doctor Answers (15)

Insurance hernia repair

+2

If there is a true hernia, then a repair would clearly be covered by your insurance company.  A tummy tuck will not be covered by your insurance company.


Dallas Plastic Surgeon
5.0 out of 5 stars 55 reviews

Insurance coverage of a tummy tuck

+2

A tummy tuck is a safe and effective procedure to contour the abdomen, create a tight waist, and remove extra skin, fat, and stretch marks.

Many of our patients have this procedure done at the same time as another surgery such as a gynecological procedure or a hernia repair. If you have a pre-existing umbilical hernia, your best bet is to work with a plastic surgeon who is board-certified and has great deal of experience with abdominoplasty, liposuction, and body contouring. They will be able to document the presence of your hernia and initiate the process where this hernia repair may be performed at the same setting as a tummy tuck. This is a very popular combination as part of your surgical and anesthesia costs may be covered by insurance and more importantly you'll only have to go through a single recovery process.

Pat Pazmino, MD
Miami Plastic Surgeon
4.5 out of 5 stars 66 reviews

Tummy tuck and hernia repair

+2

What is the Best Way to Plead Tummy Tuck Case to Insurance?
I'm a mom of 2. After 2nd child I noticed that I had umbilical hernia. I got that repaired. In the Dr's summary he said "The abdominal wall was extremely thin around the hernia, and for this reason, the fascia was debrided in a longitudinal ellipse." 2 years later I start working out, abs especially, and another hernia has appeared! How disheartening! My Dr says that it's a hernia and gives a referral to a general surgeon. I don't want to get this repaired for it to only come back. Any Advice?

Tummy tuck is a cosmetic procedure and is not covered by insurance.  A panniculectomy is covered by insurance but in no means is it cosmetically appealing.  It looks as though you have a hernia again as you mentioned, so you may get that covered by insurance but for the tummy tuck portion, you would responsible for the cost.

Hope that helps.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 39 reviews

Tummy Tuck

+2

You appear to have marked abdominal wall protuberance, related perhaps to abdominal wall weakness, but also to your weight.  It will be difficult or impossible to improve by abdominal exercise, and I've had patients built like yourself with disabling back problems.  My recommendation is to lose the weight first by seeking professional help, either a reputable weight loss center or, if indicated, by bariatric surgery.  See your primary care physician to discuss.  You will benefit significantly from abdominoplasty, but I would lose the weight first.  DON'T SAY YOU CAN'T, AND DON'T SAY YOU'VE TRIED.  JUST MAKE UP YOUR MIND YOU WILL DO IT, AND STICK WITH IT UNTIL YOU DO.  YOUR BODY IS THE MOST PRECIOUS ITEM YOU OWN, TAKE CARE OF IT.  You will look and feel fabulous afterward.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 38 reviews

Tummy tuck and insurance

+1

Unfortunately, tummy tucks are not covered by isnurance, but if you have a true hernia, that certainly would be.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Tummy tuck is elective cosmetic surgery

+1

I agree with my colleagues in this case.  A tummy tuck is an elective cosmetic procedure that women undergo to improve the appearance of their abdomen after having children.  Hernias are covered by insurance and there are times that small umbilical hernias are fixed at the same time, and it is conceivable that the insurance would cover the general surgeon (or even possibly plastic surgeon) to repair this during a tummy tuck; however, the tummy tuck is not medically necessary and would not be a covered benefit to any insurance plan.  Even in extreme cases that have advanced skin breakdown and rashed from the "skin on skin" contact and maceration, the insurance company only covers a panniculectomy which is NOT a tummy tuck and does not have as pleasing a cosmetic appearance. I hope this helps!

Sincerely,

James F. Boynton, M.D., F.A.C.S.

James F. Boynton, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 20 reviews

Hernias are covered by insurance, tummy tucks are not

+1

Simply enough, you can have your hernia done and covered by insurance as medically necessary but removing the extra skin and tightening the rest of the muscles in a tummy tuck is not medically necessary (it is cosmetic) and is not covered by insurance.  

The two surgeries can be done at the same time but the tummy tuck portion is your responsibility to pay for.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 49 reviews

Tummy tuck and insurance coverage

+1

To be fair, getting insurance to cover a tummy tuck may not be appropriate. Your hernia repair should be covered by insurance as it is a medical condition.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
5.0 out of 5 stars 18 reviews

Tummy tuck is a cosmetic operation

+1

I am a bit wary when a patient seeks insurance coverage for procedures that generally are considered cosmetic, and so are insurance companies. Basically, if you have a hernia, then hernia surgery is medically indicated and is usually done by a general surgeon, although plastic surgeons often repair hernias as well.

If you are seeking to COMBINE a medically indicated, insurance-reimbursed hernia repair with an abdominoplasty (tummy tuck), you may be able to avoid a second operation and second anesthetic, but you will most likely still be responsible for paying out of pocket for that component of your surgical time (the surgeon's, anestheiologist's and facility's time and costs) that is devoted to the abdominoplasty. Also, be aware that hernias around the belly button can require maneuvers to repair which may compromise the blood supply to the belly button if a simultaneous abdominoplasty is done. In some cases, that may result in loss of the belly button, which may have to be reconstructed later.

My personal bias is to recommend that hernias be fixed in a separate, medically indicated, insurance-reimbursed procedure and not combined with abdominoplasty in most cases, as it may avoid some of the blood supply/healing issues that can be compounded when the procedures are combined.

From an ethical standpoint, a plastic surgeon must be impeccable in not succumbing to a patient's potential desire to "pass to insurance" the costs of what is honestly a cosmetic procedure. There are some cases where a procedure similar to the standard cosmetic abdominoplasty, called a panniculectomy, may be offered through insurance, but this is usually in patients with morbid obesity and severe complications associated with it.

Tim A. Sayed, MD, FACS
Palm Beach Plastic Surgeon
5.0 out of 5 stars 14 reviews

Recurrent hernia formation of abdomen versus tummy tuck

+1

You are more likely to get insurance coverage if you have this repaired as a hernia. Preventing recurrence may be related to several factors you should discuss with your hernia surgeon.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 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.