I need a tummy tuck covered by insurance. I have extenuating circumstances & need to know if this is possible? (Photo)

Question

I am 51 and want the front of my abdomen & "kangaroo pouch" removed. I had 2 large children via c-section & have gained weight since then. I currently weigh approx 225-230. I suffer from repeated rashes & also have rheumatoid arthritis so I am on immuno- suppressants & biologics. Any infection, even my rashes, are cause for concern. My hope is that there is a doctor who can help me regain a flat stomach. I also need to learn about healing time & down time .. Thank You for your tile

Martin Jugenburg, MD · Answer

Abdominoplasty surgery is not covered by insurance as it is not medically necessary. However, Panniculectomy surgery may be covered by insurance. Regards,

Jerome Edelstein, MD · Answer

Hello,Thank you for your question and photos. Abdominoplasty is not covered by insurance as this is not considered a medically necessary procedure, however sometimes Panniculectomy- excess skin removal only- can be covered with a referral from your Doctor. Your overall health picture, Body Mass Index and your goals/expectations will help determine what is the best procedure for you.I recommend that you book an in-person consultation with a board certified Plastic Surgeon to find out what your options are.All the best

Nelson Castillo, MD · Answer

Thank you for your question and photographs.  Unfortunately tummy tucks are never covered by insurance as they are deemed cosmetic and not "medically necessary."  There is a smaller procedure which they will occasionally cover, termed a puanniculecomty, which allows for removal of the apron of skin and fat that can predispose patients to rashes, ulcerations and infections.  You will need to reach out to your insurance company to see if this is a covered procedure for your plan.  Either surgery places a large incision on your body that you will need to heal from, which needs to be addressed in light of your history of immunosuppressants.  Immunosuppressants not only impair your ability to heal from rashes but can impair your ability to heal the skin after a tummy tuck.  Be sure to see a board certified plastic surgeon in consultation for the best recommendations.

Thomas Trevisani, MD · Answer

Based on your photo- you are a great candidate for Abdominoplasty. Insurance questions are best answered by reading your policy and determining if the extended procedure is both medically necessary and a COVERED expense. Just because it's medically necessary does not mean the policy will cover it. You say you have extenuating circumstances- and these may in fact get you some coverage. Most Plastic Surgeons will require payment in flu pre-operativey and then supply the needed documents to make your case. You then fight with the insurance company. You may also want to consider significant weight loss.

Nicholas Tarola, MD · Answer

Thank you for your question.  The only abdominal procedure covered by insurance companies for skin removal to treat recurrent skin rashes is the panniculectomy.  Tummy tucks (or abdominoplasty) are not covered by insurance as they are considered cosmetic in nature.  In addition, you are not a good candidate for a tummy tuck at this time secondary to your current weight.  The surgeon who stated that you are a great candidate for a tummy tuck was mistaken, I believe.  A great candidate for a tummy tuck is one who is healthy, at a stable weight with a BMI less than 30 but ideally close to 25, and has realistic expectations.  I suggest you consult with a board certified plastic surgeon to discuss your options.  Best wishes!

Darryl J. Blinski, MD · Answer

99% chance no health insurance coverage is available. But depends upon what heath plan you signed on for! Most restrict TT for any reasons!

I need a tummy tuck covered by insurance. I have extenuating circumstances & need to know if this is possible? (Photo)

Answers (6)

More Tummy Tuck Questions

Will I be able to wear a bikini after a full Tummy tuck ?

Spitting stitch on a Tummy tuck. Any suggestions? (photos)

Tummy Tuck verses FDL Tummy Tuck?

Tummy tuck incision opening, white inside! HELP (photos)

I am having a lower body lift that includes a tummy tuck; would it be important for me to wear a Fajas compression garment?

How do you decide where to place a tummy tuck scar?

WE SEND PRETTY
EMAILS