When is a Body Lift Covered by Insurance?

I understand that most of the time, body lift surgery isn't covered by medical insurance, but in certain cases it is. What are the normal criteria for having a body lift paid for by insurance?

Doctor Answers (34)

Insurance coverage for Body Lift

+4

Generally speaking, insurance companies will not pay for a total body lift, but may pay for parts of it. Insurance companies will only pay for procedures they (not your doctors) have determined are "medically necessary", and often have strict criteria for each procedure to be covered. Each plan is different, but sometimes you can find requirements for coverage online depending on your carrier.

Also note that "total body lift" includes different things depending on the surgeon. A circumferential body lift typically addresses the excess skin on the front and back of the abdomen or trunk, and helps lift the lateral thigh and buttock regions in doing so. There are also procedures for medial thigh lifts and arm lifts.

Procedures that have a greater chance of being covered are panniculectomy (distinctly different from abdominoplasty) and abdominal hernia repair. If done at the same time as your body lift, sometimes these "medical" portions can be covered by insurance, with the remaining "cosmetic" costs covered by the patient.

In a standard ABDOMINOPLASTY, or tummy tuck, the overall result is a flatter and smoother abdominal contour, with removal of excess skin and lower abdominal tissue, tightening of the widened abdominal muscles, and repositioning of the belly button. This is considered a "cosmetic procedure" by all insurance companies and is not covered.

The PANNICULECTOMY is different, and only removes the overhanging "apron" of skin and tissue from below the belly button. In the strictest definition, nothing else is done and the two skin edges are closed together and the shape of the abdomen and skin is the same except that lower hanging apron is gone. Even this is not covered by insurance unless you can show them you have a medical reason to have it removed (for example repeat infections due to the overhanging skin, inability to walk because the weight of skin limits your knees, etc)

Despite all of the difficulties with insurance, the total body lift is a very gratifying procedure for both the patient and the surgeon. If cost is an issue, you can always look for board certified plastic surgeons who offer financing, or have the procedure done in more than one step. Choose a safe surgeon that you are comfortable with.

Good luck!


Beverly Hills Plastic Surgeon
4.5 out of 5 stars 12 reviews

Insurance: The exception and not the rule

+3

Insurance companies are making their approval criteria for panniculectomies more and more stringent. Careful documentation and care from a primary cary physician are often required.  

10 years ago, almost all body contouring procedures after massive weight loss were covered by insurance. As the popularity of bariatric surgery increased, so did the requests for post-bariatric body contouring. Insurance companies took note of this and became more selective on their approval process. 

Recently, the only procedures covered by insurance are breast reduction and panniculectomy. Ironically, most patients that have undergone massive weight loss have deflated, sagging breasts, and need a lift, not a reduction. 

A panniculectomy is an "entry level" tummy-tuck. It is removal of the skin apron only. It is not considered cosmetic.

Criteria currently required (as of 2010) for insurance approval include:

  • Bariatric surgery 1 year ago or more
  • Weight loss of 100 pounds or more
  • Stable weight for a minimum of 6 months
  • Skin disorder: rash, ulcers, infections unrelieved by documented medical therapies
  • A minimum amount of breast tissue (for breast reductions) to be removed based on Body Surface Area
  • A certain amount of sagginess of the skin of the abdomen (below or at the level of the genitalia)

William A. Wallace, MD, FACS
Jacksonville Plastic Surgeon
5.0 out of 5 stars 20 reviews

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Each insurance is different in terms of qualifying for coverage

+2

Hello,

Thank you for the question.  A body lift is also referred to as a lower body lift or sometimes as a circumferential abdominoplasty.  It generally involves an incision around the waist and combines a tummy tuck in the front, thigh lift on the sides, and buttock lift in the back.  An insurance company may cover the front portion of the body lift if there are skin irritations that do not respond to conservative care, if there is excess skin that interferes with exercise, or other issues.  Each insurance company and individual is different so its often hard to know if a procedure will be covered.  You can always have your prospective plastic surgeon submit the procedure codes to your insurance company and see if they will cover it.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 98 reviews

Insurance Coverage For Body Lifts

+2

In the Seattle area there are very few insurance companies that will pay for body lifts.  If you are hoping to get help with insurance, first check your benefits booklet or place a call to your company to inquire. If it is a covered service, they will often give you the criteria they use.  With that information you may strategize how to get the doculmentation they require to preauthorize in your behalf.  Do not waste your time if it is not a covered benefit, no matter how compeling your reasons are. Good luck! 

Mary Lee Peters, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 94 reviews

Body Lift and Insurance Coverage

+2

A body lift is generally not covered by insurance as it is deemed cosmetic surgery.  However, a panniculectomy (removal of an apron of excess skin hanging below the waist) may be covered if you have documentation of skin rashes, infections or other problems.  Usually, insurance companies require medical documentation of these problems persisting for at least six months.  You need to check with your insurance company to find out the details.  So although a body lift is not covered by insurance, a panniculectomy may be covered in very specific situations.  A body lift can be completed at the same time as a panniculectomy, but there will be additional cosmetic fees for the surgeon's time, Operating Room and anesthesia fees.  Hope this helps.

Dr. Basu

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 124 reviews

Body lift paid by insurance?

+1
We are able to get insurance coverage for most of our post bariatric bypass patients that have lost much weight. We send photos in, letters explaining the functional problems the patient is having. I see many patients from out of my area and we do that for them, also. If that does not help, and that may take a long time with reviews, then we do offer several excellent financing options and give substantial discounts to patients willing to appear on camera and tell their story.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 23 reviews

Body Lift Coverage by Healthcare Insurance

+1
In considering a body lift, costs are certainly an issue. The cost can be covered by your healthcare insurance carrier, although that is becoming increasingly rare. Every healthcare insurance carrier has their own set of specific criteria, which can be obtained by contacting them. The issue is whether you are truly suffering from medical problems related directly to the large flaps or folds of skin consequent to your weight loss. The insurance carrier will usually require documentation of these medical problems and any supporting documentation such as radiology reports, medication prescriptions, and other medical reports. In their assesments for coverage, they usually want to ensure that all conservative measures and treatment modalities, short of surgery, have been tried and have failed. Obtaining all of this documentation can be a lengthy, tedious, and frustrating process, which is sort of the point of it all. Any Board-certified plastic surgeon well versed in this process should be able to help you out. Good luck and fare well.

Daniel Kaufman, MD
New York Plastic Surgeon
5.0 out of 5 stars 5 reviews

When is a body lift covered by insurance?

+1
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.

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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

INSURANCE COVERAGE AND BODY LIFTS

+1
A body lift or belt lipectomy involves three procedures – a tummy tuck, a lateral thigh lift, and a buttock lift.  Unfortunately, insurance companies do not provide coverage for those particular procedures as they are considered cosmetic.  This even holds true for massive weight loss patients after bariatric or gastric bypass surgery.  While some insurance companies may provide coverage for weight loss surgery they rarely pay for the body contouring needed after surgery to remove the excess and sagging skin.  Be sure to research only board certified plastic surgeons and then schedule a consultation for a thorough exam to make sure you are a candidate for a body lift.

Be well and good luck!

@norrisplastic

Morgan E. Norris, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 17 reviews

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.