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

Question

Would this be qualify as medically necessary? My apron is more of a level I and I haven’t had any significant weightloss. I actually gained 30lbs after last pregnancy and haven’t been able to lose more than a few lbs without regaining it all. I DO however have this chronic rash/lacerations under the bust and then, in between my labia majora and thighs, it is 10x worse! Both areas get very sweaty and have foul odor. I am constantly getting unexplained UTIs and BV. I have chronic lower back pain 2

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding whether your panniculectomy is medically necessary. In my opinion, your panniculectomy is medically necessary. The constant rashes you have are because of the excess skin folds and the moisture that is harbored under the abdominal skin. In addition, it is led to other infections like UTIs and BV. Also, the sheer weight of the abdominis pannus gives you low back pain. All these reasons, in my opinion, make your panniculectomy medically necessary. However, having the insurance company determine if it's medically necessary is very different. Proving medical necessity will be determined upon your plastic surgeon's letter to the insurance company. Also, photo documentation of your rashes will be necessary. It will also be beneficial to provide your insurance company receipts for medications to purchase treatments for your chronic infections. Therefore, I believe your panniculectomy is medically necessary. However, getting approval for your panniculectomy with your insurance will require work.

Adam Kinal, MD · Answer

Dear IDreamofCurves, Thank you for your question and photographs. However, getting a proper assessment with an in-person examination is easier. Don't hesitate to contact several Board Certified Surgeons who specialize in these procedures to get their evaluation. Several types of tummy tuck and panniculectomy procedures may be available. A Tummy Tuck will address the skin of the upper and lower abdomen and more. Still, it is advised to seek an in-person evaluation with an experienced surgeon specializing in these procedures. Good luck.

Kenneth Hughes, MD · Answer

Some insurance companies do not require a specific BMI to cover a panniculectomy. Instead, they consider medical criteria such as chronic skin rashes, wounds, infections, odor, and other medical issues.
The panniculectomy will produce the best results with the lowest risk of complications during and after surgery if you have lost most of your excess weight or your weight loss has stabilized for a period of months. You may qualify for weight loss surgery if your BMI is over 35 and you have a serious weight-related health problem, such as high BP, severe sleep apnea, or type 2 diabetes.
Consult with a board certified PS to discuss how to prepare for the panniculectomy surgery.

Daniel Barrett, MD · Answer

Dear iDreamOfCurves,
it is hard to tell for sure without an examination. There is a chance that insurance will cover the costs of a panniculectomy. If you are considering a surgery, I would suggest you to 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

A panniculectomy will remove the hanging apron of skin that reaches essentially hip to hip.  It will not address rashes under the breasts nor issues from friction between the thighs and labia.  I encourage you to visit with your primary care physician who can assist with topical treatments for the rashes.  Guidance can also be given for a nutritionist to assist with weight loss.

H. Joseph Naim, MD, FACS · Answer

Removal of excess skin from the lower abdominal area, particularly after significant weight loss, is almost always covered by most PPO insurances. The three requirements are that a) It not be an excluded procedure b) One presents enough documentation to show that's it is medically necessary c) The excess skin must hang over the public area. As such, they may ask for prescriptions documenting use of ointment & antibiotics, plus photos showing the skin folds with rash and irritations. Some ask for 6 months of above treatments...

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

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