Would Insurance Cover a Tummy Tuck After Gastric Bypass?

I Had Gastic Bypass Surgery in Nov 2010 Have Saggy Breast and Inner Tights and Need a Tummy Tuck Will my Insurance Cover It

Doctor Answers 7

Insurance and TT

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Unfortunately, insurance does not cover a tummy tuck. Occasionally with documentation of recurrent infection they will pay for a panniculectomy (simply removing loose skin).

Usually not, but it depends on your situation

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You will have to consult your insurance provider to find out if your tummy tuck is covered. However, in general, the answer would be no unless it would resolve a physical impairment directly caused by excess skin and fat as well as separated muscles in the area you want to target, and a tummy tuck is proven to be the most suitable treatment for you.

Will insurance cover my tummy tuck?

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I see many patients who have lost significant amount of weight and have a lot of loose sagging tissue., One of the main areas is the tummy. I usually can correct this as an outpatient and can even safely combine it with other procedures. We normally do submit letters, photos to the patients insurance carrier to get possible coverage.This may take a long time but it is well worth it for the patient. I am presently the President of the American Society of Bariatric Plastic Surgeons and our members, who specialize in this type of surgery, are actively trying to help cut our patients costs.

Edward J. Domanskis, MD
Newport Beach Plastic Surgeon
4.5 out of 5 stars 28 reviews

Would insurance cover a tummy tuck after gastric bypass?

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Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.  Commonly, body contouring procedures following massive weight loss is not covered by insurance. 

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Removal of excess skin after gastric bypass

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The short answer is sometimes insurance will cover removal of excess abdominal skin. Less frequently they will cover breast surgery (depending on how much tissue needs to be removed) and I have never seen insurance coverage for inner thighs. Whether your insurance will cover these procedures depends on your policy. The best way to find out is to prior authorize it with your insurance company. Your board certified plastic surgeon should be able to do this for you. Good luck.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

Usually not.

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What you want is considered cosmetic in nature and thus not covered by insurance. The most insurance covers is the removal of an apron of skin that hangs down over your pubic region. The cosmetic improvement needs to be self paid.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Tummy tuck coverage after gastric bypass

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Insurers have tightened their rules, now that gastric bypass surgery is an everyday occurrence. Unless your abdominal skin apron, or panniculus, has ulcerations or breakdowns which do not respond to dermatologic or antibiotic treatment, the major insurance carriers now deny coverage for this as cosmetic although, ironically, some government sponsored plans will pay for it. Breast and thigh lifts are not covered by insurance and are performed on a fee forcservice basis.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.