How do I get started with getting my panniculectomy covered by insurance? (Photo)

Question

I have lost 120 pounds and I get frequent rashes as well as terrible back pain and I am very depressed due to my skin. I have been a consistent weight for 1 year as well.

J. Timothy Katzen, MD, FACS · Answer

Dear Helpful485443,

Congratulations on your remarkable weight loss achievement! Losing 120 pounds is a significant accomplishment, and it's understandable that you're now looking to address the challenges associated with excess skin. Getting a panniculectomy covered by insurance can be a complex process, but with the right approach and documentation, it's possible. Here are steps to guide you through this process:

1. Understand Your Insurance Policy:

Begin by reviewing your insurance policy to understand the specifics about what types of surgeries are covered, especially regarding panniculectomy. Policies differ in terms of what they consider "medically necessary" versus cosmetic.

2. Document Your Medical Need:

Insurance companies typically require documentation that the panniculectomy is medically necessary. Start gathering evidence of the rashes, back pain, and any other health issues exacerbated by the excess skin. This includes medical records, prescriptions for treatments, and any other relevant documentation.

Photographs of the affected areas can also serve as powerful evidence of your need for surgery.

3. Seek Support from Your Healthcare Providers:

Consult with your primary care physician or a dermatologist about your skin issues and back pain. Their professional evaluation and support can be crucial. Ask them to document how the excess skin contributes to your health problems and why a panniculectomy is recommended.
Obtain a letter from your doctor(s) supporting the medical necessity of the procedure. This letter should detail how the excess skin is causing health issues and the expected benefits of having the surgery.

4. Find a Board-Certified Plastic Surgeon:

Look for a plastic surgeon who is experienced in panniculectomies and familiar with the process of obtaining insurance approval for such procedures. They can provide additional documentation and help argue the case for the surgery’s medical necessity.

5. Prepare for Pre-Authorization:

Your plastic surgeon’s office will likely handle the pre-authorization process with your insurance company. This involves submitting all the gathered documentation and letters to argue the medical necessity of the procedure. Be prepared for this process to take some time and possibly require additional information.

6. Be Persistent:

Insurance companies may initially deny coverage for a variety of reasons. If this happens, don't be discouraged. You have the right to appeal the decision. Many patients have successfully obtained coverage through persistence and by providing additional documentation or clarification.

7. Consider a Consultation with an Insurance Specialist:

Some plastic surgery practices have insurance specialists who can offer guidance and assist with navigating the insurance process. Their expertise can be invaluable in making a compelling case for coverage.
Maintaining your weight consistently for a year demonstrates your commitment to a healthier lifestyle and strengthens your case for the medical necessity of a panniculectomy. With thorough preparation and the support of your healthcare providers, you're taking a positive step toward improving your quality of life and wellbeing.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Camille Cash, MD · Answer

You can begin by visiting with a board certified surgeon to be evaluated for a panniculectomy.  Your information will be submitted to your insurance company for approval.  Once you have reached your goal weight you may want to consider a full tummy tuck.  This will address excess fat and skin as well as correct abdominal wall laxity.

H. Joseph Naim, MD, FACS · Answer

Some insurances cover panniculectomy. First you have to find a doctor that will perform panniculectomy and/ or tummy tuck.Then you have to find one that also accepts your insurance.Most policies ask patients to do up to 6 months of medical treatment of this condition, prior to authorizing surgery.

How do I get started with getting my panniculectomy covered by insurance? (Photo)

Answers (3)

More Panniculectomy Questions

Panniculectomy/tummy tuck with abdominal hernia history - what can I do?

Weight maintenance after breast reduction and panniculectomy

Should I wait to have my Panniculectomy until after another pregnancy?

PCP won't refer me for panniculectomy / tummy tuck. Will more weight loss or creams help with skin tearing? (photos)

My consultation was with the coordinator - is that the norm?

Will Medicaid cover a Panniculectomy? (Photo)

WE SEND PRETTY
EMAILS