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Are There Circumstances Where Insurance Covers a Tummy Tuck?

I have had 2 MAJOR abdominal surgeries. Now I have Rectus Diastasis!! I had an growth on my liver in 2009. They opened my abdomen to repair and took out half of my liver. One year later I was back in under the knife with a huge Hernia. The surgeon went into the same scar to repair this and used mesh. I have severe back pain on a daily basis, a huge belly with a "plateau". Saw a Plastic Surgeon- he does not accept insurance. Is there an instance where I can get insurance to cover the tummy tuck?

Doctor Answers (8)

Insurance coverage for TT

+1

Insurance will not cover tummy tuck or diastasis repair. The hernia should be addressed by a general surgeon. Best results for any surgery are if you are close to your ideal weight. Sorry, I know its not what you want to hear.


Tampa Plastic Surgeon
4.0 out of 5 stars 14 reviews

In rare instances, insurance may cover a tummy tuck

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Repair of separated muscles and or removal of loose, hanging skin caused by massive weight loss, pregnancy or multiple surgeries is often not covered by insurance.  This varies from state to state and by insurance company.  Excision after massive weight loss is often covered, but other causes are often not.  It is worth seeing a surgeon certified by The American Board of Plastic Surgery who is on your insurance plan to discuss your options.

Elizabeth Slass Lee, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 33 reviews

Will insurance cover a Tummy Tuck....?

+1

On extremely rare occasions insurance "may" cover a tummy tuck.  What is more common is for them to cover what is called a Panniculectomy.  The is basically a procedure for patients who have an overhanging roll of  skin of the lower abdomen.  But, even this must me "medically necessary".  That means there has to be a good medical reason as to why you would need to have this removed.  It cannot be just because you don't like it.  Your back pain would be a good reason, but often that alone isn't enough either.  Infections beneath the roll of skin is also a good reason.  The insurance companies often each have their own criteria that they look for.  So, if you have a roll of the lower abdomen, that may be covered.  You would need to be examined, photos taken and a letter written to the insurance company to obtain pre-authorization. 
Good Luck
Dr M

Daniel P. Markmann, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 69 reviews

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Insurance Coverage for a Tummy Tuck

+1

Insurance companies usually do not like to pay for any procedure.  Every insurance plan is different and so you will need to check with them specifically.  It is very rare that the insurance will pay for a tummy tuck.  Some possible indications are; if you have chronic infections or skin breakdown in the area underneath the pannus, If you have other chronic problems, back pain, henias, etc.  Best to talk with your specific insurance company.  Have the issue documented by a primary care physician.  Then please see a few Board Certified Plastic Surgeons.

Jeffrey Roth, MD
Las Vegas Plastic Surgeon
4.5 out of 5 stars 7 reviews

Does insurance cover tummy tuck?

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I have had only one patient approved by insurance in the past few years. She was status post a 150 lb weight loss, with a hanging panniculus so large that it hung midway to her knees. The skin under the crease had been so infected that she had been admitted to the hospital three times in a year and had become resistant to most antibiotics. Back pain should be treated orthopedically. A scar revision may be covered. I will also caution you that, given your medical history, you should know that your conditions must be such that an internist will clear you to undergo surgery.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 11 reviews

Any insurance protects plastic aesthetic surgery excepts in accidents or breast reduction/ningun seguro proteje cirugias plastic

+1

perhaps you may inquire for previous surgeries and perhaps would it be authorized by previous exsisting  scars proves on your belly

quiza  tu puedas pedir por las cicatrices previas en tu abdomen , alguna  concesion pero lo veo algo dificil

Ramon Navarro, MD
Mexico Plastic Surgeon

Insurance Coverage for a Tummy Tuck

+1

Each insurance company and plan has different guidelines for coverage. I the surgery is for cosmetic reasons then an insurance company will be unlikely to provide coverage.

There may be a few scenarios for patients who have a medical necessity that an insurance company may consider at least partial coverage for a tummy tuck.  

1. If you primary care physician can document health issues which would be alleviated with a tummy tuck.

 

2. Patients who have ventral or umbilical hernia. Again the primary care physician should be able to document a hernia.

 

3. For patients with back issues, there may be some coverage if a tummy tuck is recommended by your primary care physician, chiropractor, and/or your physical therapist.

 

Consult with 3 -4 experienced and expert board certified plastic surgeons who participate in your plan.

 

 

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 16 reviews

Insurance does not usually cover surgery on the tummy (tummy tuck) if it is for appearance.

+1

Thank you for your question.

As a surgeon, I do not represent nor can I speak for your insurance company or any other insurance company.

All I can tell you is this. If you have a recurrent hernia, then usually insurance will cover the hernia repair and placement of mesh because hernia is a medical condition that could result in severe medical problems, e.g.- bowel obstruction, incarceration, or strangulation.

If you want surgery on your tummy (or any other part of your body for that matter) where the primary reason is for appearance or to improve self-esteem, then it is consider cosmetic and not covered by insurance.

See two or more board-certified plastic surgeons in your area to be sure.  When you call to make the appointment, you can check to see if they at least accept insurance so you don't make a wasted trip.

I hope this helps. Best wishes.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 35 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.