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

Question

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.

Marco Carmona, MD · Answer

Hi.
Sometines insurance companies cover panniculetcomies since they are not considered to be a cosmetic procedure. A panniculectomy is the removal of the pannus (extra skin and fat on abdomen). SInce you are having health problems which you can document in case they ask for it. On all other body parts, the insurance companies usually don't cover the removal of excess skin.
I would recommend you to consult with a board certified plastic and reconstructive surgeon. There are also financing companies who help you with the payment of cosmetic procedures within the US, Canada or abroad. 
Kindly
Dr Marco Carmona MD

Joseph Michaels, MD · Answer

Congrats on the awesome weight loss! Unfortunately, insurance companies consider a lower body lift cosmetic. If you have skin issues related to the hanging abdominal skin, sometimes a panniculectomy can be covered during the lower body lift. This will save you some money.

Tim Neavin, MD · Answer

Thank you for your question. Difference insurance companies have different coverage types and insurance will need to be verified. I would advise you to schedule a consultation with a board
certified plastic surgeon for a detailed examination to discuss all possible
treatment options and what your expectations are.

Richard J. Bruneteau, MD · Answer

It's not unusual for massive weight loss patients to develop significant amounts of redundant truncal skin. A variety of surgical options are currently available to address these problems. These include both panniculectomy and body lift procedures. The choice of procedure is dependent upon the patient's anatomic findings and aesthetic goals.It would be extremely unusual for an insurance carrier to cover the cost of a body lift procedure. Most insurance carriers would view this procedure as cosmetic in nature.In contrast, abdominal panniculectomy may occasionally be covered by insurance companies if hanging skin is associated with functional problems. Under these circumstances, back pain, rashes and severe infections related to hanging skin may lead to insurance coverage.It's important that each patient be considered individually when undergoing this type of procedure. It's, therefore, important to consult a board certified plastic surgeon. This surgeon should be able to determine what type of procedure will meet your aesthetic goals and whether or not it will be covered by insurance.

Jeffrey D. Wagner, MD · Answer

Congratulations!  Unfortunately unless your excess skin is causing a real medical problem that cannot be satisfactorily managed conservatively, surgery to remove it is not going to be covered by most third party payors.  Such situations are actually fairly rare, mostly limited to severe cases of sagging abdominal apron skin, typically with the pannus hanging as low as mid thigh and complicated by recurrent bouts of infection or ulcers.

J. Timothy Katzen, MD, FACS · Answer

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. Sincerely, Dr. Katzen

Aaron Stone, MD · Answer

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.

Jason M. Petrungaro, MD, FACS · Answer

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.

Scott Chapin, MD, FACS · Answer

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.

Jourdan Gottlieb, MD · Answer

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.

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

Answers (19)