Why Won't Insurance Companies Cover Abdominoplasty from Pregnancy Damage?

Why do insurance companies do not cover Tummy Tuck after pregnancy? Why, when there is so much scarring and damage, is it not treated as an injury that needs repair? It seems that damaged muscle and skin on any other area would be worthy of treatment--why not post-pregnancy damage? After 3 kids, I want a belly button and to sit down without extra skin touching my lap!

Doctor Answers 6

Insurance coverage for a tummy tuck

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Insurance will pay only for things that are medically necessary for you to live your life. Although the skin and muscles of your abdomen have been stretched, they are not endangering your life and are not considered medically necessary. If you have a hernia that has a risk of getting incarcerated, then the insurance might pay for that to be fixed, but if the tummy tuck is done at the same time, all additional fees for that portion would be on a cash basis

Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Insurance companies would probably go broke

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Almost all women who have had one of more children would suffer some type damage to her abdominal skin or muscles from pregnancy, especially three pregnancies.  The other alternative would be for them to increase their premiums enough to cover that, but I think most people think their premiums are already high enough.

James Tang, MD
Houston Plastic Surgeon
3.4 out of 5 stars 18 reviews

Insurance coverage for tummy tucks

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Your questions would be better addressed to your insurance company regarding the damage to your tummy after pregnancy.

Quite simply, insurance companies cover as little as they possibly can. Any payments made are considered a "loss" and as they are a business, and their main motive is profit and not your healthcare. That being said, you may wish to contact your insurance company directly and explain your particular situation.

Darrick E. Antell, MD
Manhattan Plastic Surgeon
4.7 out of 5 stars 37 reviews

Tummy tucks and insurance

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This is great question, but it really boils down to the fact that a tummy tuck addresses mostly cosmetic concerns. Even if you have difficulty with normal daily routines, insurance companies will most likely deny a tummy tuck procedure. However, if you have a hernia or other abdominal wall scarring causing intestinal problems, insurance companies may pay for a hernia repair. Then, if you want to get rid of the excess skin at the same time you can get a tummy tuck. The tummy tuck will still be considered cosmetic, but you may save money on the anesthesia and facility fees.

Insurance for tummy tucks

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Dear EAJ,

Remember that insurance companies are also in the business of making money. Not that I agree with them in their policies but unfortunately, they are able to set the rules. Don't believe for a minute that if health care reform goes through, it will be any better.

Insurance companies do not view this as a deformity but as a side effect of pregnancy. There are some high end policies that do cover everything including plastic surgery but they range in the $50,000.00 range per year.

Insurance has changed a lot over the years. Even in something like a deviated septum of the nose insurance also use to pay for the rhinoplasty portion. Now they view the cosmetic rhinoplasty portion as a separate and do not pay on this portion. The patient must pay for the cosmetic portion separately including OR and anesthesia fees if the surgery is done in the hospital.

There are many options open to you and I would suggest going in for a consultation to at least be evaluated. Many plastic surgeons do not charge for the consult and fees will vary. I know its not what you want to hear but I wish you good luck with your surgery.

Insurance in plastic surgery

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Often we get arguments from insurance companies for scar revisions from trauma and cancer surgery. Tummy tuck surgery is certainly at least in most part cosmetic, so they deny it on those grounds. They make the rules. Surgeons do not.

John P. Di Saia, MD
Orange Plastic Surgeon

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.