Will insurance partially pay for a tummy tuck?

The panniculectomy portion and the cosmetic portion can be performed and recorded separately with regard to time in the operating room for insurance purposes.Kenneth Hughes, MDLos Angeles, CA

Hi, this is a great question. There are differences in panniculectomy vs abdominoplasty/tummy tuck. First, for your insurance company to cover removal of your pannus, you have to meet certain criteria and it will depend on your insurance company as well. A panniculectomy just removes the excess skin/soft tissue below your belly button without transposing your belly button (meaning you not likely have a belly button). A panniculectomy also does not involve plication of your muscles so you will not get that tummy tuck aesthetic result. You should schedule an appointment with a board certified plastic surgeon to discuss the differences and determine if you qualify for a medical panniculectomy of if you are a candidate for abdominoplasty.#tummytuck #abdominoplasty #pannieculectomy #whatisthedifference 

It is true that the insurance will provide coverage for lower panniculectomy after major weight loss with appropriate predetermination. If you are looking for a full tummy tuck as well, your surgeon can charge an out of pocket fee for the non-covered portion. The issue is, will insurance and the anesthesiologist have add-on charges as well. This should be discussed well in advance. It could "get by" but some facilities also have package pricing for cosmetic procedures that you can negotiate before if you are worried about a later or unexpected bill.

Insurance payments for panniculectomy are certainly possible as long as you have adequate documentation.  I try as much as possible to obtain this coverage for patient if I am able to.  Unfortunately, panniculectomy does not cover extensive undermining, relocation of the umbilicus, liposuction, direct excision of fat and muscle plication all of which are often required for abdominal contouring. 

Thank you for your question.  Generally, this can be performed together if your insurance company covers panniculectomy.  Your surgeon will need to get a pre-authorization/pre-determination to determine if you are covered.   Once coverage is assured, you can bill the insurance company for the panniculectomy portion of the  surgery, including the surgeon's fee, the hospital fee, and the anesthesia fee.  The remaining portion of the abdominoplasty would be billed to you as a cosmetic procedure.  Best to check with a board certified plastic surgeon to see if you are a candidate.  Good luck.  

If your insurance carrier agrees that it is medically necessary, and that your policy offers coverage for that procedure, it seems likely that some partial payment may be made for the panniculectomy. Each insurer has its own policy, so finding out the coverage in advance is essential.All the best. 

Yes, it is possible that health insurance issuers cover just the "reconstructive" part of the surgery, which is panniculectomy, which means that the cosmetic portion will be your full responsibility.  The first step to determine the right course of action is to find a board-certified plastic surgeon--i.e., someone certified by the American Board of Plastic Surgery.Good luck and best wishes.