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?
When is a Body Lift Covered by Insurance?
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Insurance coverage for lower body lift
Insurance coverage for Body Lift
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.
Insurance: The exception and not the rule
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)
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Each insurance is different in terms of qualifying for coverage
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
Web reference: http://aaaplasticsurgery.com
Body Lift and Insurance Coverage
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.
Web reference: http://www.basuplasticsurgery.com
When does insurance cover a body lift
every insurance company is different, but usually they will cover a body lift if there are frequent rashes under the breast, if there are associated hernias. They usually try to find a way not to cover the procedures which is wrong, but you need to find a medical reason for it to be performed.
Web reference: http://www.drrickrosen.com/tummy-tuck-connecticut/
Ontario body lifts paid for by OHIP
Body lifts are generally not covered by insurance. Different jurisdictions will have different rules. In Ontario, your surgeon may apply to the Ministry of Health to seek funding for a panniculectomy. It may assist in covering a portion of the costs. Often this will offset some surgical and anaesthetic fees as well as the facility fee.
When is a Body Lift Covered by Insurance
As a rule, insurance companies do not cover a Body Lift since it is considered cosmetic in nature. However, a few carriers will cover a panniculectomy or excision of the redundant anterior inferior abdominal skin and fat. If there are documented problems with rashes or infections below the skin.
Web reference: http://www.drvitenas.com/body-lift.html
Excess skin and fat that cover the pubic region may impact medical coverage...
I have had significant success having body lifts covered by insurance. The insurance coverage completely depends on your resulting skin excess, medical comorbidities, and your insurance plan.
Typically, insurance companies cover body lifts if you meet certain criteria which can include skin rashes which do not go away after treating them with creams and lotions for over three months. Typically, these rashes occur in the pubic region, saddle bag region, and in the buttock region.
Criteria that are also required for body lift coverage include excess skin and fat that covers the pubic region. Different insurance plans have different requirements, however most insurance companies required skin and fat completely cover the pubic region.
Other criteria include difficulty keeping the pubic region clean and chronic skin ulcers both in the pubic region and in the buttock region. Other conditions that help document the need for insurance coverage include low back pain.
Often, I have patients obtain letters from their chiropractor, orthopedic surgeon, or spine surgeon indicating that removal of excess skin and fat of the lower torso would reduce the strain on the patient’s low back, hips, and ankles. I have also had body lifts approved for patients with significant knee problems requiring knee replacements for the sure fact of removing excess skin and fat and thus reducing the amount of weight on a person’s knees. Criteria that I also mentioned for insurance coverage include if indicated difficulties with intimacy due to excess skin and fat.
It should be stated clearly; however this cannot guarantee that your insurance company will approve your body lift. However, these are items which can maximize the potential for insurance coverage. Please do not hesitate to call my office to schedule a phone interview and visit my website for before and after pictures.
J. Timothy Katzen, MD, FACS
Web reference: http://timothykatzenmd.com/body/360-body-lift/
Body lifts are not covered by insurance
A body lift is generally not covered by insurance. The most they cover is sometimes a panniculectomy. This involves removing the over hanging skin of the lower abdomen only which can be a deforming operation as the excess tissue on the sides is left in place and the belly button is removed. This is a functional operation to decrease fungal infections and allow the patient to see the genital area for hygiene purposes. A panniculectomy is not a cosmetic operation so most people are very disappointed with the outcome. It is hard to argue with insurance companies that a body lift is a functional operation which is why it is generally not covered. The insurance company has the only say in if something is "medically necessary."
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.
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