When is Tummy Tuck Medically Neccessary?

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.

Hi Kwrightbigk, Hello, Thank you for your questions about when is tummy tuck "medically necessary".  This is a very common question. First of all, we need to define four key terms. 1) Panniculectomy: this is a plastic surgery procedure in which the apron of skin hanging over the pubic region is removed. During a panniculectomy procedure, the rectus abdominis muscles are not sutured and the belly button is not repositioned. 2) Tummy tuck: during the tummy tuck procedure, excess abdominal skin and fat from the  pubic region to the belly button are removed. The rectus abdominis muscles are sutured together. The belly button is repositioned.  3) Cosmetic or aesthetic plastic surgery procedures: this a procedure that takes a "normal" patient and makes them "super normal" or "more augmented".  A cosmetic plastic surgery procedure would include elective breast augmentation.  4) Reconstructive plastic surgery procedures: these plastic surgery procedures take an "abnormal" patients and make them more "normal". Typical reconstructive plastic surgery procedures would include cleft lip, cleft palate, and burn surgery.   Insurance coverage for any plastic surgery procedure varies by individual and insurance plan.  Sometimes medical insurance plans cover panniculectomies.  If the patient has severe rashes which have failed treatment with creams and lotions.  In addition, a panniculectomy  may be covered by insurance if a patient has severe, low back pain.  Insurance plans view a panniculectomy as a reconstructive plastic surgery procedure because it is taking an "abnormal" patient and making them more "normal".  It is rare, if ever, that medical insurance plans cover a tummy tuck.  Usually, tummy tucks are viewed by insurance plans as being a cosmetic procedure.  Sometimes if the patient has severe separation of the rectus abdominis muscles resulting in rectus diastasis, ventral hernia, and excess abdominal skin and fat, the tummy tuck procedure may be covered by insurance. However, insurance plans would view this scenario as reconstructive plastic surgery procedure more than a cosmetic procedure. Again, medical insurance plans do not cover cosmetic plastic surgery procedures. I hope that I have answered your questions regarding panniculectomies, tummy tucks, cosmetic medical insurance coverage, and reconstructive medical insurance coverage.     If you have any more questions regarding medical insurance coverage for a tummy tuck or abdominoplasty, please contact my office.  Sincerely, Dr. Katzen. 

A tummy tuck, or abdominoplasty, is a purely cosmetic procedure - nobody "needs" a tummy tuck.  This surgery removes excess skin and fat from the lower abdomen, tightens up the rectus muscles and often involves some liposuction - I always liposuction the flanks for a better overall result.  You might be thinking of a panniculectomy which can sometimes be covered by some insurances.  This surgery only addresses the excess skin - skin that hangs below the pubis.  In some people this skin can be heavy and cause back pain, it can cause irritation and chronic rashes in the fold and can cause a considerable amount of distress.  Despite this, in my experience it can be very challenging to get insurance companies to authorize a panniculectomy.  Hope this helps!Sincerely,Dr. Michelle Spring

Thank you for your question. Tummy tucks are rarely covered by insurance.  Occasionally, a smaller component of a tummy tuck can be covered.  This is referred to as a panniculectomy, and the procedure removes some of the excess skin fold on the lower abdomen.  For this to be covered, there has to be medical necessity such as documented skin infections with multiple attempts at medical interventions.However, it is not uncommon for patients with medical necessity to still have a tummy tuck because they are concerned about the aesthetics of the final result.  I would visit with a board-certified plastic surgeon who can review your different options with you in more detail.

A  Tummy Tuck (Abdominoplasty) consist in removing excess skin on anterior abdomen with plication of abdominal muscles ( suturing muscles together)  this is purely a cosmetic procedure.  In some patients, specially in the obese or patients after massive weight loss,  the insurances may cover removing only the lower apron that hangs over the Mons. Usually is covered on occasions where there is documented frequent rashes and infections.  This only eliminates the lower part and does not change anything with the rest of excess skin or tightening of the muscles.

Unfortunately, insurance does not cover a tummy tuck. Occasionally with documentation of recurrent infection they will pay for a panniculectomy (simply removing loose skin).#tt#tummytuck

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.

Hello! Thank you for your question! Surgical procedures for aesthetic
purposes, to improve appearance, are not covered by insurance.
Typically, these as well as complications resulting from such procedures
are the responsibility of the patient. Procedures that are meant to
correct functional issues and those which cause health-related issues
should be covered by your insurance as a medical necessity, with proper
examination and documentation. Some insurance plans have exclusion
criteria for certain procedures. Also, it is an obligation of the
surgeon not to attempt to authorize purely cosmetic procedures through
insurance.  There is a difference between a tummy tuck, which is purely cosmetic, and a panniculectomy. Discuss your issues and
complaints with a board-certified plastic surgeon to discuss these as
well as to examine and assist you in deciding which procedure(s) will be
the best for you. A discussion of the advantages and disadvantages will
take place along with the risks and benefits. Insurance companies will
vary on coverage and is always reasonable to discuss your issues with
your surgeon and primary care. It would behoove you to get as much
information as possible and even call your insurance yourself.
Certainly, pay in advance prior to your surgical procedure and options
such as financing are available if you qualify. Hope that this helps!
Best wishes!

NEVER.
Tummy tuck is a cosmetic procedure.
Panniculectomy (removal of excess skin after large weight loss) can sometimes be covered in extreme cases where the skin is causing repeated infections, cancer, or some other health problem that cannot be managed otherwise.

Insurance does not always cover everything that might be considered necessary in a medical sense, and procedures that are most often done for cosmetic reasons sucha as abdominoplasty are particularly problematic for them. It's easier just to deny coverage for such procedures categorically rather than on a case-by-case basis. When they do cover it, there would need to be clear evidence that the condition is causing significant medical problems not correctable without surgery, and this is rarely the case with tummy tucks.