How to Convince Insurance Company to Cover Tummy Tuck?

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.

Doctor Answers 25

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!

Columbus Plastic Surgeon
5.0 out of 5 stars 27 reviews

Tummy tuck and insurance

Hi, the only thing that insurance companies will cover is a panniculectomy, which is removal of the overhanging skin. Most companies will ask for documentation that you have seen a dermatologist for recurring rashes between the skin folds, and that you have undergone a significant weight loss which produced that excess skin. They will not cover tightening of the muscles which is done with a cosmetic abdominoplasty. It is fraudulent for a physician to bill an insurance company for a cosmetic procedure. Good luck, /nsn.

Nina S. Naidu, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 6 reviews

Abdominoplasty is not covered by insurance companies


Although most patients don't like it, abdominoplasty is considered a cosmetic surgery procedure and, as such, is not covered by insurance companies. The only operation that insurance companies will consider covering is a panniculectomy, in which a wedge resection of the lower abdominal skin is performed; the abdominal wall is not tightened, the skin is not lifted off the abdominal wall, and the belly button is not relocated. Insurance companies will usually only covering that procedure if patients have problems with skin breakdown, rashes, or difficulty walking due to the amount of the overhanging skin. It is no way a cosmetic procedure and the results are not comparable to abdominoplasty. If you have documentation of the above-mentioned problems, you may be a candidate for a panniculectomy.

Hope this helps. Best of luck.

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.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 27 reviews

Tummy tuck or panniculectomy

Based on the photo this is not a tummy tuck, The abdomin is very large and hangs down below the pubic area. Sometimes the insurance will pay for a panniculectomy. The panniculectomy is the removal of the excess skin that hangs below the pubic area and nothing more to get A nice looking taylored abdomin you would have to pay for the cosmetic part of the procedure otherwise you would still have an abdomin that you did not like. Even when the insurance company states that it is a covered procedure ( the Panniculectomy) the insurance company ends up not paying for it or taking numerous appeals and letters and months even years of time befor they make a final determination.

Most doctors do not want to and cannot afford to do a surgery that involved and then recieve $1100 as the entire payment and have the insurance company argue about it for such a long time. That is why the procedure was divided into a cosmetic part and a medically necessary part .

To summarize a panniculectomy only removers the skin hanging below the pubic area and the abdominoplasty is the part that makes it look good by tayloring the skin and relocating the umbilicus. The second part is cosmetic and payed by the patient.

Walter D. Gracia, MD
Fort Worth Plastic Surgeon
4.5 out of 5 stars 3 reviews

Tummy-tuck and insurance coverage

Hello and thank-you for your question and photo.

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.

Andrew T. Lyos, MD, FACS
Houston Plastic Surgeon
5.0 out of 5 stars 52 reviews

Insurance Coverage for Tummy Tucks and Panniculectomies

Thank you for your question and for including a photograph for reference.  

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

In your photo, it looks like you have a pannus, which is essentially an apron of fat and skin that hangs below your waist. Pannus removal (panniculectomy) is something that insurance can cover. However, it only removes that apron of fat/skin, and does nothing to contour the area above it. You may want to consider getting that covered by insurance, and the rest of your stomach contoured with a tummy tuck that you cover.

Does insurance cover tummy tuck?

This is a common question. Insurance will SOMETIMES cover a "panniculectomy." This is removal of excess skin which causes infections in the skin and interferes with activities of daily living; it is not a cosmetic procedure and a true panniculectomy does not improve the contour of the abdomen, it only removes the excess skin that is causing the aforementioned problems.

I hope this helps.

Bryan Correa, MD
Houston Plastic Surgeon
5.0 out of 5 stars 9 reviews

Tummy tuck, panniculectomy and insurance.

Insurance companies do not generally cover tummy tucks, however, sometimes they will cover a panniculectomy. Coverage depends on the insurance company and the situation of the patient. You may call your insurance provider yourself and ask them if they cover this procedure.

Francis X. Fleming, MD
Kennewick Plastic Surgeon
5.0 out of 5 stars 4 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.