How can I get approved for a panniculectomy?

Question

Im 5'10 268 pounds and i want to get a panniculectomy. My insurance covers it and i wanted to convince them that i need to get it done and i have hard time coping with my belly. Nothing fits clothes wise and its the only part of my body i cant loose weight on. I also started to have rushes under the fat. What can i say or do to be approved?

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding how to get your panniculectomy approved. Usually, for your insurance company to cover and pay for a panniculectomy, you need to meet the following criteria: 1) your abdominal pannus must hang below the level of pubis or pelvic bone, 2) if you lost more than 100+ lbs with diet and exercise, you must be at a stable weight for six months. Suppose you lost more than 100+ lbs with weight loss surgery. In that case, your weight must be stable for 18 months 3) you must have a documented history (in the doctor’s office) of recurrent rashes or non-healing ulcers that are not responding to an antibiotic, antifungal, or steroid creams, and 4) you must have documented difficulty with ambulation or interference with activities of daily living.   A panniculectomy solely performed to correct low-back pain is considered NOT medically necessary and usually not covered. I hope this helps answer your question regarding panniculectomy approval. 
I specialize in reconstructive plastic surgery after weight loss.  If you have any more questions regarding the panniculectomy, extended lower body lift, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact my office. Since the panniculectomy or lower body lift is a big procedure, please seek an experienced, board certified plastic surgeon with significant experience performing the panniculectomy or lower body lift. Do your research.  Make sure they have performed at least 100 panniculectomies or circumferential lower body lift 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 lower body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, 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.)

Tommaso Addona, MD · Answer

Thank you for your question.
In my experience, the best place to start for covering a panniculectomy is by acquiring letters of medical necessity. These are letters written by your providers (primary care provider, dermatologist, etc) that can document your symptoms. Once these are acquired, you can meet with a plastic surgeon for further evaluation and photos. From there, these materials are sent to your insurance provider for tentative approval.

Daniel Barrett, MD · Answer

Dear svetap,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you 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

Camille Cash, MD · Answer

You will need to prove that your condition is medically necessary.  This is typically done by showing that you have had a history of issues, such as the rashes, for which you have sought medical attention.  Visit with your primary care physician as a starting point.  She/He may refer you to other specialists as well.  Please be aware that this procedure will remove the hanging apron of skin from the lower abdomen.  It is not a cosmetic nor weight loss procedure.

Peter Andolina, DO · Answer

I have performed quite a few panniculectomies for patients over the years. The majority of my panniculectomy patients were bariatric patients who had lost a significant amount of weight and had a large amount of excess abdominal skin. Insurance companies have criteria that they go by to determine whether or not a patient will get approved for the surgery. Not all insurance companies have the same criteria but typically they like to see:- stability in a patient's weight for 6 months or more- patients typically need to be over 1 year out from any sort of bariatric or weight loss surgery- when you get rashes go see your doctor - documentation is KEY!- if you are having any sort of back pain or musculoskeletal issues that can be attributed to your excess skin go see a chiropractor or PT - once again supporting documentation is the key.- you also need to prove in some way that the excess skin is impeding your life. Insurance companies do not care that you do no fit into clothes or that the excess skin is affecting your self esteem. I'm not trying to be harsh but this is the truth. The excess skin has to affect your ability to walk, work, etc.- Pictures are important as well. Most insurance companies want to see that the excess abdominal skin that hangs down low enough and under your pubic symphysis. Your surgeon will typically take and submit the photos to insuranceThese area some general guidelines that I have shared with my patients in the past. I hope this helps. Unfortunately there are no guarantees when it come to insurance companies. You should try to call your insurance carrier to see if they'll disclose their guidelines to you and you should try to get in with a surgeon so start the process. Good luck.

H. Joseph Naim, MD, FACS · Answer

You may be an excellent candidate for Panniculectomy. Fortunately some insurances cover it as long as it's medically necessary.First you need to lose as much weight as possible, and you may want to consider Bariatric Surgery. After that, your doctor has to document and treat your skin irritation or infection with medications for 1-6 months before asking for authorization.

How can I get approved for a panniculectomy?

Answers (6)

More Panniculectomy Questions

WE SEND PRETTY
EMAILS

Answers (6)

More Panniculectomy Questions

Will I qualify for a panniculectomy on medicaid? (Photo)

Skin removal - removing that skin and recreating a new belly button? (photos)

Am I disqualified from panniculectomy/monsplasty with a history of PE?

Gastric Bypass 2 years postop - Am I a candidate for panniculectomy? (photos)

I need a panniculectomy. Would this be considered medically necessary? (Photo)

If I get a panniculectomy and not touch the upper part of my belly - will I l hate the results? (photos)

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS