Will insurance cover my arm lift after extreme weight loss? (Photo)

Question

Hi I’m a 32 y/o female who lost 200 pounds from weight loss surgery in 2019. I have extreme excess skin in my upper arms & arm pits. I have BCBS IL PPO and I was denied this procedure because it was cosmetic. I am looking to appeal. What can I do to plead my case & get this reversed? I know other people got this covered with BCBSHMO so I’m not sure why I’m being denied. I have scoliosis & see a chiropractor weekly. Can I ask them for a referral as weight from excess skin is causing back pain?

Thomas Trevisani, MD · Answer

Congrats on your weight loss! Generally speaking, body contouring after weight loss- including arm lift- are considered Cosmetic and have no medical reason to perform. There is no bodily function that is impaired by having loose, flabby, medial arm skin. There is no question that this will improve appearance of the arms, provided the scar permanency can be accepted. I am not familiar with any clinical studies that support back pain caused by medial arm excess. Best to save your money and see a Board Certified PS - a Member of American Society of Aesthetic Plastic Surgery

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding insurance coverage for an arm lift after significant weight loss. Insurance policies vary greatly, and the coverage is often determined by the specifics of your plan and the criteria set by the insurance company. A universal standard for coverage doesn't exist across all insurers. Some might cover the procedure in certain circumstances, while others may not. Typically, for insurance to consider covering an arm lift, there needs to be evidence of a functional impairment caused by the excess skin, such as persistent rashes or limitations in arm movement.
While it's possible the weight of the excess skin contributes to discomfort, it's important to note that an arm lift generally removes only 2 to 3 pounds of tissue. Thus, it might not significantly alleviate back pain.
If your current insurer denies coverage, you might explore options with other companies. However, higher premiums could be a trade-off. Always be thorough in understanding what your policy covers before making decisions.
I hope this clarifies the complexities surrounding insurance coverage for arm lifts post-weight loss. Best wishes in your journey.
Sincerely,
Dr. Katzen

Kenneth Hughes, MD · Answer

You should get in touch with those ladies who were able to have insurance cover their arm lifts as they may be able to provide you with the reasons they submitted on their pre-authorization paperwork. Arm lifts are considered cosmetic and will not be covered for extreme weight loss. Extended arm lift (down to the inner aspect of the upper arm) may cost between $8000 and $11,500.

Stefan Mark Szczerba, MD · Answer

I recommend start saving for the procedure as this cosmetic.  Those who got this covered must have had different complaints or someone in the process exaggerated or simply fraudulently claimed that they had a medical condition related.  
Some additional information regarding this may help you also:  the procedure is being rejected more frequently and the amount the insurance company pays for the procedure barely covers the surgeon's time.  Many plastic surgeons are opting out of taking insurance altogether as it is not worth the hassle of preauthorization, then ultimate payment rejection or severe discount to the physician.  Insurance is for medical conditions- like back pain, but not for excess skin on your arms.  
The good news is that when you pay for these procedures, you will likely get a better result and you will build a relationship with a plastic surgeon who can help you with other issues.

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  Unfortunately an arm lift is considered cosmetic and therefore is not covered by insurance.  It would be a difficult argument to win that loose upper arm skin would cause medical concerns.  Perhaps talk to those you know who had it covered?  Maybe they can provide some insight on what to include.

Dann Leonard, MD · Answer

Dear Deltadanielle:I understand your problem, and it is more common than not. I practice in Oregon and have a large bariatric practice and rarely can get arm lift authorized by insurance. You can appeal, but I would prepare you that the answer will still be no. It is frustrating.Sincerely,Dann Leonard, MD

Will insurance cover my arm lift after extreme weight loss? (Photo)

Answers (6)

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