Hi, I want a panniculectomy and boob repair. Is a panniculectomy covered by Alberta health care or insurance? What should I do?

Question

Hi I was 300 lbs and I've gotten down to 160lbs and I'm still losing weight. II've read that a panniculectomy is covered by healthcare if you had weight loss surgery, but not if you lost weight with diet and exercise...is this true? I've lost my weight with 3 rounds of dr prescribed and supervised Hcg diet. If it can be covered by insurance because of medical necessity, what does this mean? what do I need? from surgeon or family dr? Thank you sooooo much for taking the time to read all of this!

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding what to do with your abdomen after massive weight loss and whether a panniculectomy is covered by insurance even after dieting and exercise as opposed to gastric surgery.  The better surgery for you would be to have a tummy tuck. However, if financing is prohibitive, a panniculectomy will have to be done. Every insurance company is different in regards to coverage for a panniculectomy. In the US, a panniculectomy can be covered even if you lost weight with diet and exercise.  It is important you check with your individual provider regarding coverage for a panniculectomy. However, in general panniculectomies are usually covered for you meet four specific criteria. Criteria for panniculectomy coverage includes things like chronic skin rashes refractory to antibacterial/antifungal creams and lotions.  Your pannus must completely cover your pubic region.  Also, most insurance companies require a stable weight for 6 months if you lost weight through diet and exercise and for 18 months if you lost weight through gastric surgery.  If you meet these criteria, then your panniculectomy may be covered. It is important that you seek a board-certified plastic surgeon who has been working with insurance companies regarding authorization of panniculectomies. Thank you.  I hope that I have answered your question regarding whether a panniculectomy is covered by insurance even after dieting, HCG, and exercise.  I specialize in reconstructive plastic surgery after weight loss.  If you have any more questions regarding the panniculectomy, tummy tuck, extended tummy tuck, high lateral tension tummy tuck, abdominoplasty, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact my office. Since the panniculectomy or extended tummy tuck are big procedures, please seek an experienced, board certified plastic surgeon with significant experience performing the panniculectomy or extended tummy tuck. Do your research.  Make sure they have performed at least 100 panniculectomies or extended tummy tuck surgeries and have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.   If you cannot find an experienced, panniculectomy or extended tummy tuck surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Dhaval M. Patel, MD · Answer

Thank you for your question an photo!  I suggest you seek a board certifed plastic surgeon and have a physical examination and let the staff submit your claim via insurance.  Best of luck!Dr Dhaval Patel
Double Board Certifed 
Plastic Surgeon
Chicago
Hoffman Estates
Oakbrook
Orland Park

Kenneth Hughes, MD · Answer

Some insurance providers will cover the cost of a panniculectomy based upon medical criteria such as chronic skin rashes, wounds, infections, odor, excess skin hanging down below the pubic bone, and other medical issues.  Read your medical insurance certificate of coverage. Determine what medical information is required for your insurance to issue a pre-authorization or predetermination of benefits for your panniculectomy. Then seek consultation with a board certified plastic surgeon who can evaluate your medical condition, discuss the pros and cons of this surgery as it applies to you, and help you in completing the paperwork required.  
Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon
Los Angeles, CA

Daniel Barrett, MD · Answer

Dear ShelleyDawn,
congratulations on your weight loss. No cosmetic procedure is covered by insurance but in most cases, patients which have pannus and it causes symptoms, insurance covers the cost of panniculectomy. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hi, I want a panniculectomy and boob repair. Is a panniculectomy covered by Alberta health care or insurance? What should I do?

Answers (4)

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