Why do so many doctors not work with insurance companies for thigh lift surgery?

Insurance reimbursement is typically very low in comparison to what most plastic surgeons charge for cosmetic surgery.
Once a provider except medical insurance, part of the agreement is that the provider cannot call build a patient more than what the insurance contracted amount is.
Insurance reimbursement is usually around 10% or less of what most plastic surgeons charge for cosmetic surgery.
A procedure that might generate $12,000 if insurance is not involved, may pay $900 from insurance reimbursement.
For this reason, many plastic surgeons simply don’t want to engage with taking care of insurance based patients.
There are plenty of plastic surgeons, but do it except insurance, but insurance companies under Tori is Lee stingy when it comes to authorizing procedures that are generally considered cosmetic surgery. I personally have never heard of this company, paying for a thigh lift. Generally speaking to get insurance company to cover the procedure there Hass to be a correlating diagnosis ICD 10 code that is a condition that justifies the procedure.
For a panniculectomy that is typically going to be a skin rash.
Lots of women have skin that rubs on their inner thighs whether they were lost weight or not so I don’t think treatment for skin irritation on the thighs is ever going to be covered by insurance company.
Its your medical insurance, so you can look up to see which procedures are covered under what terms.
Contact your insurance provider and ask if they cover they left surgery and if so, what are the underlying diagnostic criteria for having the procedure covered.
When I requested insurance coverage for a panniculectomy, I would say most of the time the claims have been denied. Whenever I’ve had cases approved it almost always required an appeal and manual review.
To do this typically requires back-and-forth communication and sending in a variety of justifying information. A simple process of obtaining insurance information for a major surgical procedure can be quite labor-intensive.
There is no reimbursement for requesting insurance authorization, even if it takes hours of work.
Personally, I view a thigh lift as a cosmetic surgical procedure and don’t think it should be covered by medical insurance.
Medical insurance is a resource available to those in need, and the decision to limit expenses keeps insurance premiums under control.
Look for plastic surgeons who are involved with breast cancer reconstruction. These are often surgeons who do a lot of insurance based surgery.
Alternatively, consider academic medical centers where insurance is usually accepted as well.
You can also look for plastic surgery providers assigned to your medical insurance program.
Best,
Mats Hagstrom, MD