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 13

Insurance Coverage for Massive Weight Loss Surgery

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.

Omaha Plastic Surgeon
4.9 out of 5 stars 193 reviews

Will Insurance Cover Body Lift Procedures

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 21 reviews

Will Insurance Cover Excess Skin Removal?

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 183 reviews

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

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 113 reviews

Will Insurance Cover Excess Skin Removal

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
4.6 out of 5 stars 45 reviews

Insurance coverage

Unfortunately, insurance companies do not cover skin excision procedures for discomfort after working out.  My recommendation is that you visit with a board certified plastic surgeon in your area to learn more about your options.

Dr. Sugene Kim

Sugene Kim, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 76 reviews

Insurance companies

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".  

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 206 reviews

Excess Skin After Weight Loss

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 80 reviews

Loose skin and insurance

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 26 reviews

Insurance coverage of excess skin removal

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
5.0 out of 5 stars 1 review

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.