Panniculectomy and insurance question. Will I qualify if my skin hangs over the pubic area?

Question

I'm looking into excess skin removal after significant weight loss. I have Aetna insurance, and one of the qualifications that needs to be met for panniculectomy coverage is that the skin hangs "below level of pubis". My question is, how far does that mean? Would you qualify if your skin hung over the public area at all? Or does it have to be covering it 100%?

Richard J. Wassermann, MD, MPH, FACS · Answer

Hello Cherish-  This is an excellent question and one that our office receives often. Sadly, most insurance companies do not cover the panniculectomy unless you have a substantial amount of skin hanging well below "the pubis." What this means is that the fold of abdominal skin is covering your genitals/crotch completely. If the skin does not hang down that low, it can be very difficult to support medical necessity according to insurance.   What we find more often, is that even if the insurance company did agree to cover the panniculectomy, most patients are not satisfied with their abdomen after the procedure. The panniculectomy only removes the excess skin of the lower abdomen, but not every Doctor fixes the underlying problem of muscle separation to give your abdomen the flat appearance. Also, the panniculectomy does not include any liposuction or removal of the excess skin of the sides (muffin top). Often times we look to do the panniculectomy in combination with a "cosmetic add on" so that the insurance would pay a portion but you would be responsible for a portion as well, so that you can get the best overall outcome. We hope this helped answer some of your questions!  Best of luck!

Priti P. Patel, MD · Answer

Most insurances consider panniculectomy to be cosmetic unless there is significant functional issues associated with the extra tissue.  Its best to have an exam and have your plastic surgeon discuss your qualifications.   They will measure and take photos to submit to your insurance for potential approval.

Abdulla Fakhro, MD, FACS · Answer

Hello CherishCheyenne, one of the toughest matters for patients and surgeons alike in panniculectomy surgery are the intricacies and details that surround what is and what isn't covered. Most major insurance companies have uncompromising requirements about what is covered in their policy for every procedure. I am grateful you have already reviewed the policy, that helps a lot in your understanding of the procedure you are about to undergo.
In the past, certain companies have had strict requirements about how far the panniculus hangs, some will require it hangs to the point of concerning the genitals, others only the thigh crease. I would call the company or have your surgeon's office look into this before you sign up for surgery. The one thing i will mention is that if you are having any chronic persistent skin conditions because of the pannus, this will be covered since the procedure is now considered a necessity. Please keep good documentation of said conditions (photos, photos, photos) Unfortunately, it is not uncommon to fall short of the required criteria and be told you have to cover the costs of the procedure
Hope this helps!
This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion.The information provided should not be relied upon as a substitute for consultations with a qualified health professional.

Panniculectomy and insurance question. Will I qualify if my skin hangs over the pubic area?

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Panniculectomy and insurance question. Will I qualify if my skin hangs over the pubic area?

Answers (3)

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Everything you need to know about Panniculectomy

Our mission is to create a world where every investment in modern beauty is Worth It.