I've had gastric bypass surgery 6 yrs ago and had umbilical hernia's since now I'm having surgery again. Since I have so much scar tissue from all these surgerys can my surgeon do a tummy tuck ( a mini one or full) with it being medically nessascary? Since the bypass I've had so many problems with scar tissue in my belly and hernia's. Is it possible my dr and the INS co will ok this? Thanks for your help.
I Had a Gastric Bypas 6 Yrs Ago and Had About 5 Umbilical Hernias, and I Now Have Another. Will Insurance Cover?
Doctor Answers 6
Insurance coverage for a tummy tuck with complex medical history extremely unlikely
It is very unlikely that your insurance company will pay for a tummy tuck despite your medical history. You can attempt to submit the information but don't expect a positive answer.
Tummy tuck and Insurance Coverage?
Although not possible to know until you check with your insurance company, I doubt that the tummy tuck surgery will be covered. On rare occasions, panniculectomy surgery is covered. However, umbilical hernia repair is generally a covered benefit.
It is unlikely that your insurance will pay for a tummy tuck. They may cover the umbilical hernia repair though. Donald R. Nunn MD Atlanta Plastic Surgeon.
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A tummy tuck is not a medically necessary procedure
You will need to check with your insurance company to see what is a covered benefit for you under your plan. Typically, insurance companies will pay for hernia repairs as medically necessary but a tummy tuck is cosmetic and is not covered. Sometimes, a panniculectomy is covered. See your surgeon to discuss this in further detail to see what you are a candidate for. I hope this helps.
Check with your insurance
Recently I have seen that nearly all of the Bariatric procedures can be done with endoscopic techniques. This has resulted in less of an abdominal wall problem and fewer hernias to deal with. I have treated a number of patients with problems like yours. It is often easier to get hernias covered if done by your general surgeon. The insurance likely will only pay for panniculectomy which in itself is inadequate in most post Bariatric patients and then only if there are problems like skin breakdown.
Most centers where Bariatric procedures are performed have support groups for people considering the operation and dealing with the issues after. These are free and are often a good place to get referrals and see how others are dealing with things in your community.
Insurance coverage for tummy tuck
The short answer is it depends. And it depends on a lot of things including your individual insurance policy as well as how much weight you have lost and whether there are medical reasons for the tummy tuck such as rashes or infections. Insurance is more likely to cover removal of excess skin after significant weight loss, a procedure called a panniculectomy, rather than the procedure called an abdominoplasty which usually involves repositioning the belly button and which is usually done for cosmetic reasons. You should have a consultation with a plastic surgeon certified by the American Board of Plastic Surgery who will be able to help you determine what is the best surgical procedure for you and whether it will be covered by your insurance.
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.