I went to see about a tummy tuck and the doctor said I was a good candidate to have it done. As soon as she heard of my insurance, she said no they do not cover that. With me having hip pain, back pain, unable to do many exercises from excess skin, how does a doctor let my insurance company know it is not just cosmetic. She did not even try to help me get my insurance company to do the surgery. I would like some help in this area.
How to Convince Insurance Company to Cover Tummy Tuck?
Doctor Answers 28
Tummy Tucks and Insurance
Tummy Tucks are typically not covered by insurance. I would suggest that you contact your Human Resources Department to advise you on your benefits. Best wishes!
Insurance coverage for tummy tuck
Insurance companies do not cover tummy tucks, they are cosmetic. They do cover panniculectomy(removal of overhanging skin) when the patient meets the criteria. Each insurance company has their own criteria so you should talk to them first. They will also cover hernia repair but not the tightening of the muscles or repair of diastasis recti. Many plastic surgeons feel it is a waste of time and money for them to check with the insurance company but as the person who is covered by the insurance company you certainly should check.
Insurance tummy tuck
Thank you for your question and attached photo. Without evaluating you in person, I can't tell you if your excess skin removal would be covered by insurance. Certainly a formal tummy tuck is not covered by insurance, but removal of excess skin, referred to as a panniculectomy, is covered in certain circumstances. I would recommend you see a plastic surgeon who takes your insurance to discuss your eligibility.
Hope that helps.
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Insurance for a tummy tuck
Thanks for your question.
Unfortunately, insurance doesn't cover a tummy tuck. Insurance will cover a "panniculectomy" which strictly involves removing the "apron" of skin that overhangs the lower abdomen. A panniculectomy doesn't involve tightening of the abdominal muscles or moving or improving the belly button, which is done in a tummy tuck.
Insurance coverage for tummy tuck
Tummy Tucks are rarely covered by insurance. Check with your insurance company for surgeons who are in its network and your benefits to better understand what criteria you would need to meet for insurance coverage.
Tummy-tuck and insurance coverage
A tummy-tuck (abdominoplasty) is considered a cosmetic procedure which is generally not covered by health insurance. This procedure removes excess skin and fat, lifts the pubic area, tightens the muscles, and reshapes the umbilicus (belly button). If you have had a large weight loss and have excess skin which hangs past your pubic area (pannus), health insurance may pay for a portion of the procedure to remove it (panniculectomy). This may lessen some of the cost of the abdominoplasty, but is frequently difficult to have approved by insurance carriers. I would recommend a consultation with a Board Certified Plastic Surgeon. I wish you the best of luck,
Andrew Lyos MD, FACS.
Insurance Coverage for Tummy Tucks and Panniculectomies
In general, insurance companies do not cover tummy tucks or abdominoplasty procedures. Insurance companies will, however, consider medical coverage for a panniculectomy, or the removal of the excess skin envelope that can hang over the pubic region. With that said, each insurance company has their own specific set of criteria that must be met in order to determine that the proposed procedure falls within specific guidelines for the procedure to be deemed medically necessary.
In my practice, my surgical coordinator works closely with the patient and patient's insurance company to file a claim or appeal for medical necessity. This is sometimes a short and easy process but more often this is a lengthy process that can take several months and sometimes requires several appeals to complete. Photographs depicting the hanging skin envelope, documentation of medical necessity from primary care physicians and dermatologists, notation as to whether or not the patient has suffered skin infections or rashes as a result of the overhanging skin, documentation of significant weight loss, and sometimes letters from physical therapists attesting to the patients limitations as a result of this excess skin, etc.. will all help to strengthen a patients case for medical necessity. I hope you find this helpful.
Insurance can cover pannus removal but not tummy tuck
Does insurance cover tummy tuck?
I hope this helps.
Tummy tuck, panniculectomy and insurance.
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