I've been approved for pannus removal, but...

Question

Within the last year, I spoke with a cosmetic surgeon and he thought I was a good candidate for having my stomach apron removed. He submitted it to my insurance and it was approved. When I went to discuss how much would I need to pay if I could have a fleur di lis to prevent having to have two separate surgeries, I was told that he would not perform a procedure covered by insurance and an elective procedure at the same time? the only way to do this is to have 2 SEPARATE surgeries?!

J. Timothy Katzen, MD, FACS · Answer

Dear Bright8867,

I find myself in agreement with Dr. Adolina's perspective on your situation. Throughout my practice, both in a hospital setting and in private practice, I've encountered similar scenarios where a patient was approved for a panniculectomy through insurance and then expressed interest in paying the difference to upgrade to an abdominoplasty, also known as a tummy tuck, which includes the fleur-di-lis technique for more comprehensive contouring. Based on my experiences, this is indeed a feasible approach.

The resistance you're encountering from your surgeon might stem from the complexities and nuances associated with billing insurance for a medically necessary procedure while incorporating an elective, cosmetic component. It's understandable; navigating the intricacies of insurance billing for such combined procedures can be challenging and may require a surgeon who is not only comfortable with the surgical aspects but also adept at managing the administrative and billing processes involved.

Your desire to avoid undergoing two separate surgeries is completely reasonable, given the added recovery time, costs, and emotional toll that might entail. To move forward with your preferred course of action, consider the following steps:

Open Dialogue: If you haven’t already, try to have a candid conversation with your current surgeon about your concerns and desires. There might be room for negotiation or at least a clearer explanation of their reservations.

Seeking Alternatives: As you suggested, contacting other board-certified plastic surgeons in your area can be a productive next step. Look for surgeons with experience in both panniculectomy and abdominoplasty, and specifically, those who are familiar with handling cases that involve both insurance-covered and elective procedures.

Consultations: Schedule consultations with potential surgeons to discuss your case, your insurance approval, and your wish to have an abdominoplasty with the fleur-di-lis modification. During these consultations, inquire about their experience with similar situations and how they handle the billing and insurance aspect.

Insurance Verification: Ensure that any new surgeon you consider can verify and accept your insurance for the panniculectomy portion of the procedure. Their administrative staff can be invaluable in navigating these details.

Informed Decision: Choose a surgeon who not only understands your aesthetic goals but also demonstrates a clear plan for addressing the insurance and billing aspects of your combined procedures.

It's worth noting that while seeking a surgeon willing to accommodate your request, the priority should always be on the quality of care, the surgeon's expertise, and your safety and satisfaction with the outcomes.

Your proactive approach in seeking a solution that aligns with your goals and needs is commendable. With perseverance and the right surgical partnership, achieving your desired outcome is within reach.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Gary M. Horndeski, MD · Answer

If the insurance has approved pannus removal then they will also approve this done using a fleur de lis technique.  This is not two separate surgeries.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

The two procedures you are considering overlap to a degree.  The panniculectomy simply removes overhanging skin.  The fleur de lis tummy tuck would remove overhanging skin too but also addresses abdominal wall laxity and removes excess skin on the abdomen resulting in an improved contour.  It may be challenging finding a surgeon to perform both as mixing an insurance procedure with a non medical procedure can be tricky to navigate.

Vincent Gardner, MD · Answer

Hi Bright8867, You raise an interesting question&hellip;.mixing cosmetic and medical procedures. First, congratulations on getting your panniculectomy covered by insurance. This is usually a difficult thing to do. I’m excited for you. Getting rid of the skin will most likely greatly improve your day-to-day experience. Having said that I don’t blame your surgeon for not wanting to mix medical and cosmetic and for that reason we do not accept insurance in our cosmic practice. I’m not saying you can’t find somebody that would do it, so if you’re set on having everything done at once then I would recommend you keep searching. Good luck!

Peter Andolina, DO · Answer

I've been in similar situations in the past where a patient was approved for an insurance case like a panniculectomy and then wanted to pay the difference to have an abdominoplasty.  As far as I know that is possible to do.  I have done this in both a hospital setting and private practice.  Perhaps the surgeon does not feel comfortable with the insurance billing of such a procedure seeing as it can be a bit more challenging and less straight forward.  You can try to contact other surgeons in your area to see if they would be able to accommodate your request.

I've been approved for pannus removal, but...

Answers (5)

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