Will Insurace Cover Tummy Tuck to Fix Painful Rashes?

Question

I want a Tummy Tuck because where the fat hangs, I'm always taking care of rashes and small cuts.  This is very painful and I need help to tuck the stomach area.  Will insurance pay for this?

George Marosan, MD · Answer

A tummy tuck is a cosmetic procedure to remove excess skin and repair the stretched out anterior abdominal wall muscles. I personally also do liposuction of the upper abdomen, flanks, hips, upper buttocks and back to achieve the best shape. A panniculectomy is done to get rid of the excess skin overhang and stop skin rubbing on skin which results in the medical problems you are experiencing. This might be covered by your insurance. If that is what you are interested in, I would refer you to a general surgeon. I do not do panniculectomies in my practice, they do not look pleasing, but will solve your skin issues. You do not state your height and weight, other medical problems you might have and it is possible that you are not a candidate for a tummy tuck.
web reference: www.bellevueplasticsurgeons.com

Robert M. Wald, Jr., MD · Answer

Occasionally, insurance covers excision of excess skin when rashes occur under the overhang of tissue. Documentation by a family doctor over a period of a year is usually necessary. Various treatments also need to be documented. I have seen patients who have undergone gastric bypass and their abdominal lipectomy is covered for similar reasons. Most of the time, it depends on the insurance company.

Shahram Salemy, MD, FACS · Answer

It really depends on your specific case and your insurance, so I would recommend having an exam and seeing what your plastic surgeon thinks. Some insurance carriers are stricter than others, and they may want photos, etc. before they will agree to pay for it.

David Shafer, MD, FACS · Answer

In most cases, insurance will not cover a tummy tuck or abdominoplasty. This is the medical terminology for a cosmetic procedure. However, in some cases, insurance companies will cover a panniculectomy, which is similar to a tummy tuck but is done for medical reasons. In most cases, the reasons are massive weight loss, chronic sores, etc. This procedure typically just involves removing the excess skin, but does not involve tightening the muscles.

Sam Jejurikar, MD · Answer

In rare circumstances, including a documented history of rashes and wounds, an insurance company may cover a procedure called a panniculectomy.  This is a wedge excision of overhanging skin.  It's important to realize that this is a functional operation, not a cosmetic one, and the results are not comparable to a tummy.  In a tummy tuck, the skin is removed and the muscle is tightened to try to obtain a flat, pleasing contour of the abdominal wall.  In a panniculectomy, extra skin and fat is wedged off; nothing else.
Not all insurance companies cover this procedure - some have specific exclusion criteria.  It's best to contact your insurance carrier to see if this is a covered benefit.  If it is, start with your primary care physician to see if conservative management is effective in healing your wounds and cuts.  If it is not, then your insurance carrier may consider paying for a panniculectomy.  Again, though, do not expect results that are comparable to a tummy tuck.
Best of luck.

Otto Joseph Placik, MD · Answer

Although insurance companies have paid for tummy tucks in the past due to either muscle repair or complications such as rashes, etc. it is increasingly less likely that they will do so. Even if it is covered, they are more likely to pay for the less complicated procedure of panniculectomy (no muscle repair and no liposuction). To help find out if your specific insurance company will cover this procedure, you can have a physcian compose a predeterminaltion of benefits letter to your insurance company with supporting documents such as letters from your primary care physician, prior history of treatments for the rash and/or photos of the rash.

Tom J. Pousti, MD · Answer

I have never had an "insurance" entity authorize  tummy tuck surgery. In other words, insurance companies do not consider this operation medically necessary. Sometimes, however insurance companies will cover excision of lower abdominal wall skin/apron;  this operation is called a panniculectomy. The panniculectomy operation involves excision of the lower abdominal wall pannus or overhanging skin/adipose tissue. It is not considered an  aesthetically driven procedure;  it is often performed to help with concerns such as skin breakdown, infections/rashes… 
Best wishes.

Joseph M. Perlman, MD · Answer

Having reviewed cases for insurance carriers, and being familiar with their criteria, most insurance companies require that the rash has been documented by a physician for at least six months and has not been improved with nonsurgical treatment. By that I mean, topical antibiotic powders and creams, oral antibiotics and what they consider "conservative therapy". If your case meets that criteria, then they may authorize a panniculectomy, which is just removing the overhang of skin and fat that hides the area of the rash. They will not cover the traditional abdominoplasty, which requires elevating the skin and fatty tissue off the underlying muscle layer, tightening the muscles in the midline from the breast bone to the pubic bone, repositioning the bellybutton.

Christopher L. Hess, MD · Answer

If you have a large pannus or hanging tissue, it may be possible for your insurance to pay for removal of the fat. This is not an abdominoplasty but a panniculectomy and does not involve tightening the muscles and may involve removal of the belly button. Insurance will not pay for a standard abdominoplasty.

Peter A. Aldea, MD · Answer

Insurance do not pay for cosmetic surgery, An Abdominoplasty is a cosmetic procedure and the vast number of insurance companies will NOT knowingly pay for it .
An operation they MAY pay for is a PANNICULECTOMY (CPT 15831), the isolated cutting off of the Tummy overhang. Period. A relatively short procedure  with no undermining of the skin to the rib cage edges. No removal of skin excess above the transverse tummy fold with relocation of the belly button. No muscle repair.
While a panniculectomy removes the overhang, it will NOT give you a flat tummy but the rashes should resolve.
Hope this was helpful.

Will Insurace Cover Tummy Tuck to Fix Painful Rashes?

Answers (12)

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