How many inches below pubis does skin have to hang for insurance to cover a panni? Will docs do panni & reduction? (Photos)

Question

Consultation scheduled on 6/5. hoping insurance will cover both a panniculectomy and breast reduction. I am 29, BMI 34 and have had 5 pregnancies in the past 7 yrs and weight loss surgery (2013) which have all contributed to sagging excess skin. We have been advised it would be life-threatening to have more children, so I feel it is a good time to restore and repair my body. Hoping to have insurance cover a breast reduction and lift, and panniculectomy with abdominal muscle repair.

Richard J. Wassermann, MD, MPH, FACS · Answer

Hello!   Thank you for your questions and for providing pictures, it can be more helpful in providing an response that can be more specific to you. Every insurance company is different, and they also can vary from state to state in what their coverage will allow. Breast Reduction surgery is usually approved by insurance based on documentation, but the most important part the insurance looks for is the BSA (body surface area) vs grams per side to be removed. What this means is the lower the BSA (based on height and weight) the lower the number of grams required to be removed to be considered medically necessary. For example, a person with a BMI of 34 would likely require an estimate by a physician of 650 grams (or more) per side to be removed for them to consider it "medically necessary." As for the panniculectomy, this one can be more difficult. Having multiple children does not make it medically necessary to have the excess skin removed. There are specific guidelines per insurance company to see if they would be willing to cover this procedure, and many from 2018 and on are not approving it unless a patient has had massive weight loss of greater than 100lbs, has a pannis that hangs lower than your pubis (when standing, not leaning over) and have documentation supporting skin fold problems like rashes, open sores, and yeast. Consult your Board Certified PS to get your specific information and so they can submit to your insurance to see what they will cover-best of luck!

How many inches below pubis does skin have to hang for insurance to cover a panni? Will docs do panni & reduction? (Photos)

Answers (1)

Recommended reading

Everything you need to know about Panniculectomy

Our mission is to create a world where every investment in modern beauty is Worth It.

How many inches below pubis does skin have to hang for insurance to cover a panni? Will docs do panni & reduction? (Photos)

Answers (1)

Browse related questions

Recommended reading

Everything you need to know about Panniculectomy

Our mission is to create a world where every investment in modern beauty is Worth It.