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 26
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.
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.
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Insurance coverage for tummy tuck
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.
Insurance companies may cover a panniculectomy, but not a tummy tuck.
If you have a medically-documented case indicating that your excess lower abdominal skin impedes your hygiene, is the site of recurrent rashes or recurring skin infections, or makes it difficult for you to walk, your insurance company will likely cover a panniculectomy. The surgery is purely to restore your health and functionality, and does not have the same aesthetically-improving results of a tummy tuck.
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.