How to Convince Insurance Company to Cover Tummy Tuck?

Thanks much for a reaching out.   Having your insurance company pay for your tummy tuck can be a very difficult endeavor.   One of the biggest things they consider a medical reason is recurrent skin rashes under the skin fold that hangs. They usually like this to have failed conservative treatment which includes creams and the like. Usually you would have to have seen a dermatologist for six months without any improvement for them to cover surgery.  I hope this helps :-) 

Many years ago insurance companies would sometimes cover tummy tucks. This is no longer the case. Unfortnately patients are led to believe this can happen by uninformed primary care docs or other mis-informed people. Tummy tucks are performed in order to improve the appearance of the abdomen by removing skin and tightening the muscles. Insurance companies only cover "medically necessary" procedures. Rarely, mostly after massive weight loss, there can be a heavy redundant lower abdominal fold, or pannus. If this pannus is causing probblems such as chronic skin breakdown or infection that remains resistant to maximal medical therapy, a panniculectomy can be performed that is sometimes covered by insurance plans. However, this should not be confused as giving you the same result as a tummy tuck. The panniculectomy involves only the removal of the lower fold. 

A tummy tuck (abdominoplasty) is a cosmetic surgery, so it is NOT covered by insurance. This should not be confused with a panniculectomy, that can be covered under certain conditions set by your insurance company. The two procedures are very different!
 A tummy tuck involves skin undermining and tightening all the way up to the rib cage, "repositioning" of the umbilicus, tightening of the abdominal wall muscles, and is frequently combined with liposuction of the upper abdomen and flanks for better contouring. It is a wonderful aesthetic operation, with amazing results.
A panniculectomy only involves removal of overhanging skin (apron) in the lower abdomen, which is about half the extent of skin removed in a typical tummy tuck. No surgery is done around or above the umbilicus, no muscle repair or tightening is done, and no contouring with lipo is involved. Therefore, it is NOT an aesthetic operation, but rather a surgery done to improve hygiene in the lower abdomen and supra-pubic area. Insurance companies have different criteria for approval of panniculectomy, but they usually require documentation of severe, recurrent rashes or skin infections not responsive to medications and topical agents. They also require photographs and medical records from all treating physicians as part of the pre-authorization process. When our patients meet the insurance criteria for panniculectomy, we help them get pre-authorization to cover that part only. This will offset some of the costs of the full tummy tuck or abdominoplasty surgery.
I recommend that you consult with Board certified plastic surgeon(s) experienced in this type of surgery, where you can discuss your goals and expectations and find out if your insurance will cover any component of the tummy tuck. Best wishes!