Insurance Coverage on Tummy Tuck for Relieving Pain?
- Asked by dtesta5552 in Bayport, New York
- 4 years ago
Iam a female police officer, who has had three children. I am thinking about having a tummy tuck, because when I wear my gun belt, the loose skin below the belt is bothered, giving me a sharp pain in the stomach. I tried to increase the amount of running I do to no avail. Do you believe this would be a work-related or a medical condition that my insurance company might cover? I am also looking to remove the stretch marks from having kids. Kind regards.
Can a tummy tuck be covered by insurance?
Unfortunately, most insurance companies won't pay for abdominoplasty. Each insurance company is different. Sometimes the plastic surgeon can write a letter of support. In our office's experience this is just something that they don't approve. Best to see a board certified plastic surgeon who takes your insurance and go from there.
Web reference: http://www.jjrothmd.com/procedures/tummy-tuck-abdominoplasty
Insurance Coverage for Tummy Tuck?
Thank you for the question.
Although I can empathize, I doubt insurance companies will cover the abdominoplasty procedure. However, it won't hurt to try. Meet with a well experienced board-certified plastic surgeon who can write a letter to support your request.
Insurance Approval for Abdominoplasty
We had a case very similar to yours. Unfortunately, after multiple appeals, the procedure was deemed cosmetic by the Insurance Provider. I would recommend that you contact your Human Resources Department for clarification on your policy. Best wishes!
There are so many variables, it is impossible to say. It is worth talking with your human resources department so they can review policy guidelines. Also, the plastic surgeon should weigh in with his thoughts.
Good luck however.
Tummy tuck and insurance coverage.
Your argument is a reasonable one. But I have to tell you that over the last 20 years, we have tried many times to get insurance reimbursement for situations similar to yours.
Our experience is that abdominoplasty is always considered cosmetic surgery and not covered by insurance.
Getting insurance to pay for a tummy tuck
Unfortunately, this is almost never happens. However, if you happen to have a hernia as a result of having you children, then the tummy tuck can be combined with a hernia repair. This may help save some money when it comes to the anesthesia and facility fees. Talk with your plastic surgeon about the need for a CT scan of your abdomen and pelvis to help determine if you have a hernia or not.
Web reference: http://www.DrSchreiberPlasticSurgery.com
Abdominoplasty and insurance
Greetings Officer Dtesta! There are many women in your position. Although your complaints are legimate from a medical necessity point of view, insurance companies view abdominoplasty as a cosmetic procedure. If you were to try to submit it for preauthorization, the denial letter would read, "DENIED--NOT MEDICALLY NECESSARY". They will only entertain the possibility of covering it if you had lost 100 lbs and now have a gigantic drape of skin overhanging your abdomen such that you have continual rashes that get infected. In those cases (which very few people actually qualify), insurance companies might cover the surgery. So, the good news is that abdominoplasty can be done for women such as yourself with great results and a low complication rate, but the bad news is you have to pay for it. That's just the way it is. Hope this helped you. Good luck!
Insurance coverage for a tummy tuck, unlikely
A tummy tuck or abdominoplasty is considered a cosmetic procedure and insurance co. do not cover it. Excess loose skin in the lower abdomen which is irritated by friction, clothing, moisture in the folds leading to infections and skin breakdown can be removed by a general surgeon or plastic surgeon and insurance might cover that. This is not a tummy tuck, it is a panniculectomy. This involves simple removal of the the skin that hangs over. If you wish to have the muscle tightened, define the waist line and remove the lower abdominal skin with most of the stretch marks, that's considered a tummy tuck. I often reshape the back, hips and buttocks at the same time to achieve the best results. For further information, please visit my web site: www.bellevueplasticsurgeons.com
Insurance Coverage of Tummy Tuck
It is unusual for a TT to be covered by insurance. There are some situations, however, in which it can be covered. You should seek a Board-certified Plastic Surgeon who participates with your ins. co. for a consultation. He/she can then write the ins. co. to see if it might be covered.
Will insurance cover part of tummy tuck fees?
A tummy tuck (abdominoplasty) is often done for both cosmetic and functional concerns.
Often, after a woman has completed her childbearing, there can be excess skin and fat in the lower abdomen, together with separation of the rectus abdominis muscles and rarely, hernia formation in the abdominal region.
If you have functional problems after you have finished having children, such as a vental (frontal abdominal) hernia or restriction of your functional abilities at work, you may qualify for insurance to cover part of surgical correction of this area.
While there is no guarantee, visit your Primary Care Physician (PCP) for a complete history and physical examination and for documentation of your complaints and concerns.
Your PCP may refer you on to a Plastic Surgeon who takes insurance for further evaluation. A Plastic Surgeon may recommend surgery to help correct the anatomic condition.
While insurance will not likely cover all of the fees, often part of the surgery, the O.R. time, anaesthesia and other hospital costs may be partially reimbursed by insurance.
Good luck in your endeavor and congratulations on your rewarding career!
Karen M. Horton, M.D., M.Sc., F.R.C.S.C.
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.