When is Tummy Tuck Medically Neccessary?

When would a tummy tuck be medically neccessary? Cosmetic surgery would not be covered by insurance, only if medically needed.

Doctor Answers 21

Tummy tuck, abdominoplasty or panniculectomy

First we need to define some terms. A panniculectomy removes the overhang(sometimes called an "apron") of skin and fat that in some people hangs over the pubic area. A panniculectomy does not tighten up the abdominla muscles nor does it address any loose skin or excess fat of the upper abdominal area.

An abdominoplasty (often called a " tummy tuck") removes excess skin and fat of the entire abdominal area and tightens up the muscles underneath. A panniculecotmy may be covered by some insurance companies while an abdominioplasty or "tummy tuck " is not.

Criteria for coverage of a panniculectomy can vary between insurance companies but most require a history of rashes under the pannus ("apron") which have been unresponsive to treatment with prescription medications by the patients primary care doctor, a history of low back pain and the pannus ("apron") needs to hang below the pubic area.

Los Angeles Plastic Surgeon
3.5 out of 5 stars 7 reviews

321 N Larchmont Blvd
Los Angeles, CA 90004

Insurance coverage of tummy tuck (abdominoplasty)

Each insurance plan will vary according to their coverage of procedures. However, most insurance plans will not reimburse for a tummy tuck especially the liposuction component or diastasis repair. In rare instances, instances of severe birth trauma or following massive weight loss with complications of skin breakdown, coverage is provided. Therefore, I would seek evaluation by a physician and have a letter of predetermination of benefits submitted to your insurance carrier. A photograph of skin problems may be supportive of your application.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 58 reviews

880 W Central Rd
Arlington Heights, IL 60005

Medically Necessary Tummy Tuck

Tummy tucks are rarely, if ever, deemed medically necessary. On very rare occasions, a panniculectomy may be a covered procedure if there is a history of fungal infections, etc. However, this is a very different procedure than a true tummy tuck and most plastic surgeons are unwilling to perform a tummy tuck for panniculectomy reimbursement. Therefore, tummy tucks are almost always paid out-of-pocket by patients.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

4001 Kresge Way
Louisville, KY 40207

Tummy tuck and insurance

It has been my experience that the only procedure that insurance will cover is a panniculectomy. That is removal of the overhanging skin and fat from below the belly button. They cover that whn a patient has symptoms of uncontrolled rash and infection and well as hygeine problems. All else is generally considered as cosmetic.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 22 reviews

10 Capital Drive
Harrisburg, PA 17110

Tummy Tuck and medical necessity

A tummy tuck is a purely cosmetic operation and would not be considered medically necessary at any time. A panniculectomy, in which only the overhanging skin is removed, is considered medically necessary in massive weight loss patients who develop a rash in the skin fold. Every insurance carrier has its own policy on this so it would be best to check with them if this is your situation. Good luck.

Nina S. Naidu, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 6 reviews

1021 Park Avenue
New York, NY 10028

Tummy Tuck is never medically necessary

A tummy tuck is a cosmetic procedure. It involves removing the skin in your lower abdomen and tighening the abdominal muscles. A cosmetic procedure is not covered by insurance. A patient who is having a panniculectomy is sometimes covered after a gastric bypass surgery to remove the skin that is causing rashes or skin breakdown. This does not usually include the tightening of the muscles which most patients need.

Good luck.

Andrew T. Cohen, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 22 reviews

9400 Brighton Suite 201
Beverly Hills, CA 90210

When is tummy tuck medically necessary?

By definition, tummy tuck is never medically necessary. If you have symptoms related to a large flap of skin hanging over your legs (a "pannus") then this is sometimes covered by insurance, but it is called a 'panniculectomy' and is not a cosmetic operation.

Bryan Correa, MD
Houston Plastic Surgeon
5.0 out of 5 stars 8 reviews

4850 West Panther Creek Drive
The Woodlands, TX 77381

Tummy tuck vs. panniculectomy

Thank you for your question.  In general, "tummy tuck" refers to abdominoplasty - removing excess skin and fat from the abdomen, with internal sutures to tighten the abdominal wall, aesthetic sculpting of the belly button, and often liposuction of the flanks.  This is a cosmetic operation and is not covered by insurance.  In patients who have lost a large amount of weight, an overhanging apron of excess skin - a pannus - is often left over.  This can create rashes, problems with personal hygiene, and infection.  When this is the case, insurance will sometimes cover a panniculectomy - removal of this overhanging skin, which has become medically necessary.  The additional components that define tummy tuck - abdominal wall plication sutures, umbilicoplasty, and sculpting liposuction - are not included, and not typically paid for by insurance.

Joshua D. Zuckerman, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 13 reviews

1111 Park Avenue
New York, NY 10128

Tummy Tuck And When It Can Be Medically Necessary

Tummy tuck is considered a cosmetic procedure. It is rarely a medical procedure. The only time it may be medically necessary is when the redundant abdominal wall skin are so much that frequent skin infection happen.

Colin Hong, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 30 reviews

302 Sheppard Avenue West
North York, Ontario M2N 1N5

Tummy Tuck

In my experience, general surgeons would have more experience dealing with panniculectomies. That is a procedure that may be covered by insurance. 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 66 reviews

10941 Raven Ridge Rd
Raleigh, NC 27614

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.