Will Insurance Cover Excess Skin Removal if It's Causing Me Discomfort After Exercising?

I'm a 22 year old 6ft1 male, and 3 years ago I went from being 315lbs to 190lbs. Now I have a lot of loose skin on my arms, abdomen, pecs, butt, and thighs. I recently started to do sit ups for the first time, and after a few days of doing them the skin on my butt started to break causing a painful cut and bruise. I guess that when I sit down sometimes my cheeks get squished together and I suppose if its a hard surface the skin will break.

Doctor Answers 14

Will insurance cover excess skin removal causing discomfort after weight loss?

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Insurance will not cover the vast majority of body contouring procedures because they consider them cosmetic and not medically necessary.  In rare cases, insurance might cover a procedure to amputate excess abdominal skin called a panniculectomy.  This is not a cosmetic procedure.  Insurance might pay for this if you have a history of extensive wounds, rashes, and functional impairment from the hanging abdominal skin.  Most patients do not meet the criteria for panniculectomy.

If a patient has excess hanging skin from not only the abdomen, but also the waist, lateral thighs, and buttocks, then a body lift might be the right procedure.  Be sure to visit with a board certified Plastic Surgeon for an in-depth consultation.  At your visit you will be educated on the procedure, the recovery, and the pricing involved.  

Will Insurance Cover Body Lift Procedures

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Body lift procedures are not normally covered by insurance but in the few incidences where they may be covered have specific circumstances. After massive weight loss it is common for patients to experience health related problems from excess skin that results in fungus and rashes under the pannus (lower abdominal region). Insurance will sometimes cover this particular region due to the health concerns. However, even in these cases insurance companies require documentation of tried and failed treatment for approximately 6 months before they will consider covering the procedure. Any other regions of the body that have excess skin will not be covered by insurance companies because it considered strictly cosmetic.

Scott Chapin, MD, FACS
Philadelphia Plastic Surgeon
4.8 out of 5 stars 25 reviews

Will Insurance Cover Excess Skin Removal?

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Congratulations on your massive weight loss. This is certainly a great accomplishment. When it comes to medical insurance coverage for reconstructive surgery after massive weight loss, every insurance plan is different. Insurance companies vary from state to state. Some insurance companies cover excess skin removal, whereas others do not. Even within the same state and within the same insurance company, coverage varies. I have seen small tummy tucks covered and large body lifts denied even within the same insurance plan.

The only way to tell if your insurance covers removal of excess skin is to submit a claim. It is possible that your insurance company does cover removal of excess skin. For ideally successful insurance authorization, you will need to carefully document rashes. In addition, you will need to document how this excess skin and fat restricts your activities of daily living.

Good luck with your weight loss journey. If you have any questions, please contact my office.

Dr. Katzen

J. Timothy Katzen, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 254 reviews

Will Insurance Help with the Cost of Lift after Weight Loss?

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Thank you for your question.  It is common to have a lot of excess stretched out skin after successful weight loss. Unfortunately medical insurance rarely considers surgery to remove this to be a medical necessity.  Studies show that 85% of people who have dramatic weight reductions want to have plastic surgery to restore their shape, and at least 20 % do have the surgery.  It would be valuable to find a surgeon well experienced in this type of work to explore your options. Good luck!

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 117 reviews

Will Insurance Cover Excess Skin Removal

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By-in-large the insurers consider this skin removal after massive weight loss to be cosmetic and not "medically necessary."  Many policies specifically exclude skin reduction procedures, thereby not having to deal with considerations of medical necessity. 

That doesn't mean that it is not worth trying. 

You seem ready for an in person consultation. RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S.
Thank your for your question, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Insurance companies

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I concur with my colleagues here.  It is extremely unlikely insurance companies will cover removal of your excess skin because they deem these procedures as not medically indicated and as purely cosmetic.  In addition, more and more insurance plans are now listing skin excision procedures on their list of "not covered benefits".  

Excess Skin After Weight Loss

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Dear GrowingPain89,

For the most part, insurance companies are not going to cover the procedures you would be needing to address your concerns.  There are rare situations where a patient has significant medical problems due to the excess tissues, most commonly in the abdominal area from the apron of skin and tissue-called a pannus-that hangs down over the thighs.  This requires documentation that multiple other previous treatment efforts have failed and even then, many insurers will not cover the procedure.

Your first step is to consult with a board certified plastic surgeon who is familiar with management of the post-massive weight loss(PMWL) patient who after a consultation and an examination can best advise you on your course of action.  I know this is probably not the answer you wanted to hear but....it is best that you know what you are up against before you get started.  Best of luck.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.7 out of 5 stars 88 reviews

Loose skin and insurance

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Insurance does not cover loose skin excision after weight loss.  Sometimes they cover loose skin associated with severe rashes that are porperly documented and unamenable to conservative treatment.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Insurance coverage of excess skin removal

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If you want insurance coverage you will need medical record documentation of these problems. You need to see your GP for these complaints and have them generate a paper trail describing the tissue breakdown and attempted treatments that failed. Most insurance companies want documentation of skin breakdown and 3 to 6 months trials of non-surgical treatment even though once skin breakdown or rashes appear they never fully respond to non-surgical treatment.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Does insurance pay for excision of excess skin after weight loss?

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The standard I have seen applied by insurance companies is that the skin breakdown be refractory to dermatologic and antibiotic treatment of at least one year's duration. Induration and bruising alone will not suffice.

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.