Would I qualify for insurance to cover my panniculectomy? (photos)

Hello, and thank you for your question regarding whether insurance will cover your panniculectomy. Based on your pictures, your abdominal skin does cover your pubic region, which is a common requirement for many insurance companies when determining coverage for panniculectomy. However, it is important to note that each insurance company has its own set of criteria, and approval is not guaranteed.

Most insurance providers require documentation that the excess skin is causing medical issues, such as rashes, skin infections, chronic moisture buildup, back pain, or difficulty with hygiene. If you have been experiencing any of these issues, it is crucial to document them with your primary care doctor or a dermatologist. Many insurance plans require at least six months of conservative treatment before approving surgery. This treatment may include prescription creams, physical therapy, or weight loss efforts.

Another factor that insurance companies evaluate is stability of weight. Since you have lost 60 pounds and are now stable at 190 pounds, this may work in your favor. Some insurance plans require a minimum period of stable weight (often 6-12 months) before approving panniculectomy.

To maximize your chances of insurance approval, I recommend scheduling a consultation with a board-certified plastic surgeon who has experience with insurance-covered panniculectomies. They can help you navigate the approval process by submitting clinical notes, photographs, and a letter of medical necessity on your behalf. Your surgeon's office may also check your specific insurance policy to determine what is required for coverage.

While insurance coverage is never guaranteed, your case does meet some common requirements based on your description and photos. I strongly encourage you to gather medical documentation, consult with a plastic surgeon, and work with your insurance provider to understand their specific policies.

I hope this helps clarify the process for insurance coverage of a panniculectomy. Best of luck, and I hope you can move forward with a solution that improves your quality of life.

Sincerely,
Dr. J. Timothy Katzen, MD, MBA, FACS, FICS

You will need 360 tummy tuck, with fleur de Lis, muscle repair, I don’t think insurance cover your case.

Hi & thanks for your question!
Not all insurance companies will not cover this surgery. I would contact your insurance company to see if this is a covered benefit for you. I recommend calling plastic surgeons in your area to find one who performs this procedure through insurance. Best wishes!

Dear RoCoGirl2000,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thank you for sharing your photos and for your questions and congratulations on your weight loss! After losing a significant amount of weight, it is very common to have bothersome extra skin or pannus. Two common procedures to address this are a panniculectomy or an abdominoplasty. A panniculectomy just addresses the sagging skin/fat of your lower abdomen/tummy, but does not reposition your belly button or tighten your abdominal muscles. Insurance will often cover this procedure, if you meet certain criteria (such as documented back pain or rashes that require treatment and fail to improve with other non-surgical interventions). An abdominoplasty is generally considered a cosmetic procedure that also removed the hanging skin/fat of your lower abdomen, but also repositions your belly button and tightens your abdominal muscles. For both of these procedures, it is important that you are at a healthy and stable weight. It is important to meet with a fully-trained plastic surgeon who can discuss all options with you and tailor an individualized approach to you.

I encourage you to begin by contacting your insurance company to determine if this is a covered benefit under your policy. If it is, each policy will have certain criteria that must be met for coverage. Often this includes amount of skin to be removed, proof of other interventions tried in order to improve pain (ie. physical therapy), and evidence of other issues such as rashes or infections due to the hanging skin.

First of all, congratulations on your weight loss. In response to your question about insurance coverage for a panniculectomy I am going to begin by saying that each insurance company has its own criteria that needs to be met before they will cover such a surgery. There are some general guidelines an tips I can offer on this matter. The first thing I would do is to contact your insurance carrier to see what their requirements are in order to get the surgery covered. Typically they want to see that the excess abdominal skin hangs below your pubic bone, from your pictures I think it does. Next you are going to need supporting documentation from other physicians, physical therapists, chiropractors, etc. I would start by going to your PCP about your back pain so they can have it documented and have them refer you to a therapist or chiropractor. Also if you get any sort of rashes or areas of skin breakdown to the underside of your pannus/abdominal skin, you should go to your doctor or a dermatologist in order to get that documented. I would go every time you get one of these rashes, if you get them. You also need to show that the excess abdominal skin is hindering your abilities to perform daily tasks, get creative with this one and make sure you tell your doctor that information. The key to getting this procedure covered is documentation, documentation, documentation. Good luck and I hope this helps

This question come up more frequently because the thought health insurances should/would/will cover minimally based medical issues. The large pannus presented in these excellently posted photos is a pure cosmetic medical issue. Therefore, the 99% health insurance providers will NOT offer coverage. To offer an apronectomy or panniculectomy at a acceptable fee is what can be considered. One option is connect with a plastic surgery training program at a larger medical school so the residents in plastic surgery could offer reduced fees. Another is finding a boarded plastic surgeon offering acceptable fees. In Miami a pure apronectomy only could be al reasonable as $8,000. But must include travel, recovery house, extra fees. I suspect the total out of pocket in the range of $10,000+. Good Luck. Best to virtual consult with.....

Here are several steps you need to take to increase the chance of having your panniculectomy covered by your medical insurance if you live in Pennsylvania. It is important to note that a panniculectomy is not the same as a tummy tuck.
If you have undergone significant weight loss, such as after bariatric surgery, you must wait for two years and ensure that your weight has been stable for the past six months.
Contact your medical insurance provider to confirm that there are no exclusions for this procedure. It may be helpful to obtain a copy of your coverage and review it thoroughly, line by line.
Next, you need to establish that the surgery is medically necessary by following these steps:
Have a physician, such as a family doctor (not the surgeon who will perform the surgery), document your skin condition, specifically intertrigo, for a minimum of three months with ongoing medical care and without remission or with recurrence.
Both physicians need to document that your abdominal condition negatively impacts your normal lifestyle and/or job performance.
The physician(s) should document that the excess soft tissue meets specific criteria, such as hanging beyond the pubic area, and provide the necessary photos as required by the insurance company.
You will need to find a physician who is willing to take on your case and check for any special requirements from your medical insurance. This physician should also be willing to communicate with the insurance company to obtain pre-approval. Please note that if you have Medicare, it may be even more challenging to find a physician. Medicare may not provide pre-approval and may consider the procedure as cosmetic, regardless of your condition. The surgeon may only find out after the surgery is performed.
If you successfully fulfill all the aforementioned goals, you will have a chance of having your panniculectomy covered by your medical insurance.
Sean Yuan, MD