If PCP requests an abdominoplasty, will that make a difference?

Thanks for your question.  Approval depends on your insurance company and policy.  Some insurances may approve a pannulectomy rather than an abdominoplasty with sufficient documentation of medical necessity.  Hope this helps…best of luck!

I am so sorry to hear about your back. You will need to call your insurance company and discuss the matter with them. My best,Dr. Sheila Nazarian@drsheilanazarian on Instagram

If there is a functional issue that might be improved by and abdominoplasty insurance can certainly be approach for coverage. It helps that a primary care physician is part of the process. Your chosen plastic surgeon will take advantage of this when discussing your case with the insurance company.

Thank you for your question and I am sorry to hear of your injury.  If the loss of 150 pounds has left with you with a significant apron of hanging skin and adipose tissue you may qualify for a procedure termed a panniculectomy which can be considered for insurance coverage.  Similar to a tummy tuck this procedure removes this apron of skin which may be causing additional back pain by pulling you forward.  See a board certified plastic surgeon in consultation. They can best advise you on treatment options. 

Thank you for the question.  It is extremely uncommon for an insurance provider to cover an abdominoplasty, regardless of who requests it. You may have better luck trying to obtain insurance coverage for a panniculectomy. I have been able to have insurance pay for panniculectomies with proper documentation from their primary care physicians. It is difficult to say what procedure would be best for you without photos. Please see a board certified plastic surgeon for an in-person examination and to discuss the specific details of the procedures. Ask to see before and after photos to get an idea of what can be achieved. Hope this helps.

An abdominoplasty is considered a cosmetic procedure and is not generally covered by insurance. You may be able to qualify for a panniculectomy which is a different procedure. This surgery removes an apron of fat that hangs from the abdomen. There is no muscle tightening or contouring involved.

Hello and thank you for reaching out. That is a terrible injury, and I'm sorry to hear about that. When it comes to insurance approved abdominoplasty procedures, even if your PCP recommends one to decrease your pain level, it is ultimately up to the insurance company to determine if it is medically necessary or not. Clinical notes and documentation to support why your PCP feels that you would need the surgery can always help the pre authorization process, but that process would need to be started by the surgeon that will perform the abdominoplasty. I would suggest seeking a board certified plastic surgeon to see and evaluate you for the recommended procedure. Best Wishes.