After having had three c-sections, my lower belly has loose skin and a huge smiley face. I would like to know, is it common for insurance to cover tummy tuck to remove the excess skin?
Common for Insurance to Cover Tummy Tuck?
Doctor Answers (12)
A tummy tuck or abdominoplasty procedure is a cosmetic procedure and not covered by insurance. A panniculectomy is removal of the fat and skin in the lower abdomen without the tightening of the muscles. This may be covered by insurance but it is usually approved for patients with large lower abdominal pannus with skin issues such as rashed and infections.
Common for Insurance to Cover Tummy Tuck?
Insurance Coverage for Tummy Tuck
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Tummy tuck is cosmetic and is not covered by insurance
A true tummy tuck (tighten skin, abdominal wall) is considered cosmetic and is not covered by insurance. However, a VERY large area of loose skin may be covered and would be called a panniculectomy. You would need to show that this large fold of skin is causing some kind of medical problem such as frequent skin infections and rashes. After 3 c-sections, you would probably do best with a cosmetic tummy tuck. Ask your plastic surgeon which procedure would be best for you.
Tummy tuck or abdominoplasty is a cosmetic operation.
Insurance does not cover a tummy tuck. Loose skin and stretched out abdominal muscles are not considered a "functional" medical problem, but are cosmetic. The only procedure an insurance co. might cover is a panniculectomy. This is a condition mainly seen in patients who underwent massive weight loss and now have an abdominl fat apron that covers the pubic area or even can reach down to the mid thighs. Often these patients have infections and skin breakdown in the folds. Removing this excess skin only is a panniculectomy. It is performed mainly by general surgeons ( oddly, they like to call this a tummy tuck). It is not a tummy tuck, it is part of a tummy tuck.
Consider a Cosmetic Tummy Tuck to Address your Concerns
An abdominoplasty could fully correct the loose muscle and excessive skin resulting form three children and a c-section scar. This is an elective cosmetic procedure. I know of no insurance companies that would cover it. You might be able to see your OB/Gyn for evaluation of a scar revision though and this is sometimes covered however it sounds like you may require more than a scar revision.
Tummy tuck surgery is not covered by insurance
Tummy tuck surgery is not covered by insurance companies in the US. This is considered to be an elective, cosmetic procedure which is specifically excluded under insurance contracts. After three C-sections, the appearance of your abdomen as you have described it would be considered a cosmetic issue. A panniculectomy for hanging skin (as described my colleagues) is generally only covered in patients who have undergone massive weight loss procedures. Be careful of anyone who advises you that they can get this surgery covered for you, as this is insurance fraud. Good luck. /nsn
Insurance won't cover a tumy tuck
As the other doctors have said, a tummy tuck is considered cosmetic by insurance and as such it isn't covered. Even the rectus diastasis is cosmetic and a diastasis is not a hernia.
Basically, as far as insurance is concerned, if you CAN'T live with something it is "functional" or "medically necessary" while if you CAN survive with something even if you don't like it, it is "cosmetic."
Tummy tucks excluded by Insurance companies
Every insurance company I know of excludes tummy tucks from coverage. A complete tummy tuck is always considered cosmetic.
If you have an extreme case of excessive hanging skin with skin complications you might might get coverage from you insurance company. This procedure is called a panniculectomy. Make sure you have preauthorization before proceeding with any insurance covered procedure.
Unlikely for Insurance to cover a Tummy Tuck
Most insurance companies consider a Tummy Tuck a cosmetic procedure. Due to this fact, it is unlikely that your insurance will cover the procedure. However, if you have problems related to the scar or irritation due to the flap of skin, they may consider this problem functional. Your Plastic Surgeon can assist you with the pre-authorization process. If the doctor you see says all of his procedures are covered by insurance, head out the door. He is either commiting fraud or his/her results will be terrible.
For a cosmetic procedure, your cost can range from $4500 to over $10,000 depending on your region of the country. Make sure you choose a well qualified Plastic Surgeon with a good reputation in the community and ask to see photos.