Do you guys accept the Aetna Medicare advantage insurance? /Medicaid? I'm interested in getting an abdominoplasty done (Photo)

Question

Im struggling to find a surgeon up here (traverse city Mi) that accepts my insurances, I had the GBS in November 2010, but since last summer, I really started losing weight and id like to get a tummy tuck, I'd love to have more energy to run round with my almost 4yo, and my oldest will be 9y this summer, I'm also hoping that if I can have it done, it'll help me not breakdown the skin on my feet, I've had to lose 7toes already, so not having to carry the extra weight would be AMAZING!!

J. Timothy Katzen, MD, FACS · Answer

Thank you for reaching out with your inquiry regarding the potential coverage of abdominoplasty by Aetna Medicare. Your shared history and photographs were very helpful, and I commend you on your impressive weight loss journey.

To address your question, it's essential to understand that Medicare, including Aetna Medicare, very rarely covers an abdominoplasty. The procedure they are more likely to cover is called a panniculectomy.

Panniculectomy Explained:
A panniculectomy is a surgical procedure that involves the removal of the pannus (the excess skin and tissue) that hangs down over the genitals and/or thighs. This procedure primarily aims to alleviate the symptoms associated with an overhanging apron of skin, such as skin infections or rashes. It does not involve repositioning the belly button, nor does it address excess skin and fat in the upper abdomen. Additionally, a panniculectomy does not tighten the rectus muscles (commonly known as the "six-pack" muscles). In essence, it is a more functional rather than cosmetic surgery.

Given this, if you're hoping for Medicare coverage, they would most likely only cover the cost of a panniculectomy, given that specific criteria are met. However, if you are seeking a full abdominoplasty, which is more comprehensive and cosmetic, you will likely need to finance the procedure out-of-pocket.

To locate a Medicare-accepting plastic surgeon, I recommend visiting the official Medicare website or dialing the 1-800 number located on the back of your insurance card. Inquire about board-certified plastic surgeons in your area that accept your insurance. Typically, these surgeons can be found at larger hospitals that have plastic surgery residency programs.

I hope this information clarifies the differences between the procedures and the associated coverage nuances. I wish you all the best as you move forward with your decision.

Sincerely,

Dr. Katzen

Ronald J. Edelson, MD · Answer

Insurance companies almost never cover a tummy tuck. Your case may be more extreme than most and get covered. You should call your insurance company and find out what steps you need to go through. If they will cover it , try going to a university plastic surgery program. Mist surgeons don’t want to do tummy tucks under insurance

Connie Hiers, MD, FACS · Answer

For insurance to cover a tummy tuck, you will have to have lost over 100 pounds and have issues like skin rashes. Also, your primary care physician will have to have treated these rashes for at least 3 months, and then refer you for this.  Insurance does not always cover the tucks.

Camille Cash, MD · Answer

A tummy tuck is considered a cosmetic procedure and is not covered by insurance.  At times insurance will cover what is called a panniculectomy where a hanging apron of abdominal tissue is removed.  However this is not the same as a tummy tuck.  There are companies that offer financing for tummy tucks and other procedures, as an option to consider.

Mats Hagstrom, MD (license on probation) · Answer

Tell me a touch is a cosmetic operation that is not covered by medical insurance. One part of a tummy tuck is excision of dependence. Skin of the lower abdomen called a panniculectomy. I panniculectomy is sometimes covered by medical insurance if patient meet certain criteria. Getting this procedure authorized is difficult and many people did not meet the criteria for having a panniculectomy.
 Apparently correct me it’s not a tummy, tuck and patience need to learn the difference between the two procedures. Patients who are still significantly obese should lose weight to become a good candidate for skin reduction surgery.
Your post is insufficient to make an assessment regarding your candidacy for either a tummy tuck or panniculectomy. I suggest having consultations with local board-certified plastic surgeons who take medical insurance. You may want to consider consulting with an academic medical center if there is one in your community.
Best,
Mats Hagstrom, MD

Do you guys accept the Aetna Medicare advantage insurance? /Medicaid? I'm interested in getting an abdominoplasty done (Photo)

Answers (5)

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