Approval chances for panniculectomy? (Photo)

Question

I have a bmi of 34.7 Diagnosed with CVI PVD Obesity Circulatory system disorder Prediabetic Etc I just had an umbilical hernia repair done 12/18 along with a partial umbilicaloplasty due to getting rashes within my belly button. My pannus affects me with everyday activities. Especially toileting and showering as I cannot see my vaginal area when looking down etc.

J. Timothy Katzen, MD, FACS · Answer

Hi Honest783143,

Thank you for your question regarding the approval chances for a panniculectomy. I appreciate your history and picture. Approval for a panniculectomy depends on several factors.

Approval for a panniculectomy is based on your anatomic condition. Most insurance companies require documentation of rashes, low back pain, and difficulty in keeping the area clean. Additionally, they often require that the abdominal pannus completely covers the pubic region, meaning from a frontal view, the pubic region is obscured by excess skin and fat from the lower abdomen.

Coverage for panniculectomy also depends on your insurance. Some policies categorically do not cover panniculectomies. Others may not provide coverage if your BMI is over 30, or for patients who have undergone weight loss procedures. Insurance companies with higher deductibles are generally more likely to approve a panniculectomy compared to those with lower deductibles.

Additionally, approval can depend on the letter your plastic surgeon submits to the insurance company. Surgeons who frequently work with insurance companies for pre-authorization for a panniculectomy are more likely to submit a successful application compared to those who do not regularly handle such cases.

To maximize your chances of approval for a panniculectomy, I suggest reducing your BMI to less than 30, choosing the best medical insurance you can afford, and consulting with a plastic surgeon experienced in obtaining prior authorization for panniculectomy from insurance companies. Good luck.

Sincerely,
Dr. Katzen

Carlos Marciales, MD · Answer

Hello, well, you need to lose weight to be able to have a safe plastic surgery, A paniculectomy could be made in the event that you lost approximately 15 pounds

Charles G. Polsen, MD · Answer

From my experience, insurance plans typically require specific criteria for panniculectomy approval. These criteria often include photographic documentation demonstrating that the redundant abdominal skin extends to or below the level of the symphysis pubis. Furthermore, evidence of chronic or recurrent skin infections or irritation within the abdominal fold, despite conservative management, is usually necessary. Finally, documentation of functional impairment resulting from the pannus, such as hygiene difficulties, is generally required.

Camille Cash, MD · Answer

Approval for panniculectomy will depend on the criteria that must be met for approval.  This will vary by policy.  The best place to begin is a call to your carrier to inquire about coverage.  Another option is a tummy tuck.  This is considered cosmetic but is more comprehensive than a panniculectomy.

Approval chances for panniculectomy? (Photo)

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