Do I qualify for apron removal and how can i get private insurance to cover? (photos)

Question

I'm a 38 year old female that had a gastric bypass 3 years ago. I went from 389 to 180. I have a large appron. I am wondering if i have done enough to qualify for removal surgery? I deal constantly with skin irritation under the appron. If i dont keep creams or powders on i break out in a painful rash. this appron really needs to go! I have private insurance but they consider this elective surgery. Is there anything a dr can do to show that this is not just cosmetic but effects my way of life?

Mary Ann Contogiannis, MD · Answer

Congratulations on your weight loss! It is unfortunate but insurance companies will pay for the gastric by-pass procedure but rarely pay for the panniculectomy afterwards. Most insurance companies do not have this procedure as a benefit and if they do the redundant skin just about needs to be hanging down to the lower thighs. Of course in those situations there also has to be medical necessity established. It sounds like you do have medical issues but if your insurance company does not feel that it is enough to allow the surgery after considering them then it is not going to be approved. And a panniculectomy is not an abdominoplasty. I am sure that you can schedule a consult with a board certified Plastic Surgeon who can help you work through these questions. Good Luck.

Kenneth Hughes, MD · Answer

This will have more to do with the specifics of the insurance policy than anything else.Kenneth Hughes, MDLos Angeles, CA

Tom J. Pousti, MD · Answer

Thank you for the question and congratulations on your very successful weight loss!   Best to check directly with your insurance company to see if the panniculectomy is an operation that is potentially covered. Then, seek consultation with board-certified plastic surgeons who can support you when it comes to preoperative authorization. The more support you have from your other physicians as well, the better.
 Generally speaking, insurance companies MAY cover excision of a lower abdominal wall skin/apron;  this operation is called a panniculectomy. The panniculectomy operation involves excision of the lower abdominal wall pannus or overhanging skin/adipose tissue. It is not considered an  aesthetically driven procedure;  it is often performed to help with concerns such as skin breakdown, infections/rashes…  You may find the attached link, dedicated to patients who have experienced significant weight loss, helpful to you as you learn more.
Best wishes.

Gregory Sexton, MD · Answer

Panniculectomy is the term used for removing the "apron" or pannus. In order to have any chance of getting an insurance company to cover it, it must be deemed medically necessary, meaning the apron is causing medical problems. Documented skin infections will help. Remember, this is not the same as an abdominoplasty.
Good luck, 
Greg Sexton, M.D.
Columbia, S.C.

Do I qualify for apron removal and how can i get private insurance to cover? (photos)

Answers (4)

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