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.

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15 Doctor Answers | Asked by kwrightbigk in richmond,va

Doctor Answers (15)
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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... more

Defining "Medical Necessary" for Panniculectomy - "Tummy Tuck"

Thanks to the medical insurance companies and Medicare / Medicaid the English language has undergone an Alice in Wonderland like transformation. I'll give you a few examples:- ELECTIVE surgery - surgeon and / or patient choose the TIME / place of surgery (opposite of EMERGENT surgery (such as burst appendix, stab to heart) when one needs to be rushed to the OR)- COSMETIC surgery - a component of Plastic Surgery in which we operate on NORMAL people to improve their appearance- RECONSTRUCTIVE... more

Medically necessary Tummy Tuck

The answer to your question depends on the exact description of what the problem is. There are two procedures regarding the abdomen: tummy tuck (abdominoplasty) and panniculectomy. A tummy tuck is considered cosmetic in nature and is NEVER covered by insurance. If you have a large, heavy apron of skin which is hanging over your lower abdomen and is causing back pain, infection and irritation, then a panniculectomy is performed. The procedure removes the excess, hanging skin and is... more

Tummy Tuck is NEVER medically necessary

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.

Tummy tuck and medical necessicity

The answer is never. Tummy tuck is by definition, a cosmetic procedure. Lesser procedures like panniculectomy may be an insurance covered procedure- it includes removal of skin and fat, but no muscle tightening. Still, that would be dicey too, depending on your particular coverage.

Tummy Tuck

Cosmetic Surgery is never covered by health insurance. While insurance companies sometimes call a procedure cosmetic it may be reconstructive. A reconstructive procedure is one where you restore the abnormal to normal, a cosmetic procedure improves on the normal. If the procedure in question is a tummy tuck you are improving on a normal condition presumable excess skin and far. When the excess skin hangs down and covers the pubic area it is a panniculectomy and sometimes the health... more

Tummy Tucks rarely medically necessary

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... more

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.

Tummy tuck never medically necessary.

Hi. After extreme weight loss, people can develop a big roll of hanging skin over their groins. Removing this (panniculectomy) is medically necessary. But a regular tummy tuck is not.

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... more

Otto Joseph Placik, MD

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Chicago Plastic Surgeon

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Comments (1)

cher61777 7 Oct 2012

I have a very large stomach apron that appears to be causing me much pain, i am 5' and 268 lbs, when i sit or stand i have a tremendous amount of pain in my very lower stomach area under where the stomach hangs, it causes a lot of pressure in my lower area, groin area, and my legs ache, if I try to hold my belly up the pain seems to get better or seems like it would if all that skin wasn't there. I have had this for the last 15-20 yrs but the pain just got worse in the last 5 yrs and its difficult to walk, breath or move around. when I walk I want to just die. what is causing this and is there anything I can do? I want to lose weight, but it is impossible for me to exercise, I know if this abdominal pannus was gone I could walk, and do all kind of exercise. Respectfully Yours, Cher Blanco

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