When would a tummy tuck be medically neccessary? Cosmetic surgery would not be covered by insurance, only if medically needed.
When is Tummy Tuck Medically Neccessary?
Doctor Answers 25
Tummy tuck, abdominoplasty or panniculectomy
First we need to define some terms. A panniculectomy removes the overhang(sometimes called an "apron") of skin and fat that in some people hangs over the pubic area. A panniculectomy does not tighten up the abdominla muscles nor does it address any loose skin or excess fat of the upper abdominal area.
An abdominoplasty (often called a " tummy tuck") removes excess skin and fat of the entire abdominal area and tightens up the muscles underneath. A panniculecotmy may be covered by some insurance companies while an abdominioplasty or "tummy tuck " is not.
Criteria for coverage of a panniculectomy can vary between insurance companies but most require a history of rashes under the pannus ("apron") which have been unresponsive to treatment with prescription medications by the patients primary care doctor, a history of low back pain and the pannus ("apron") needs to hang below the pubic area.
Medically Necessary Tummy Tuck
Tummy tucks are rarely, if ever, deemed medically necessary. On very rare occasions, a panniculectomy may be a covered procedure if there is a history of fungal infections, etc. However, this is a very different procedure than a true tummy tuck and most plastic surgeons are unwilling to perform a tummy tuck for panniculectomy reimbursement. Therefore, tummy tucks are almost always paid out-of-pocket by patients.
Insurance coverage of tummy tuck (abdominoplasty)
Each insurance plan will vary according to their coverage of procedures. However, most insurance plans will not reimburse for a tummy tuck especially the liposuction component or diastasis repair. In rare instances, instances of severe birth trauma or following massive weight loss with complications of skin breakdown, coverage is provided. Therefore, I would seek evaluation by a physician and have a letter of predetermination of benefits submitted to your insurance carrier. A photograph of skin problems may be supportive of your application.
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When is tummy tuck medically necessary?
Tummy Tuck and medical necessity
A tummy tuck is a purely cosmetic operation and would not be considered medically necessary at any time. A panniculectomy, in which only the overhanging skin is removed, is considered medically necessary in massive weight loss patients who develop a rash in the skin fold. Every insurance carrier has its own policy on this so it would be best to check with them if this is your situation. Good luck.
Tummy Tuck is never medically necessary
A tummy tuck is a cosmetic procedure. It involves removing the skin in your lower abdomen and tighening the abdominal muscles. A cosmetic procedure is not covered by insurance. A patient who is having a panniculectomy is sometimes covered after a gastric bypass surgery to remove the skin that is causing rashes or skin breakdown. This does not usually include the tightening of the muscles which most patients need.
The insurance companies are looking for any way they can to not cover procedures. A tummy tuck is never covered. A panniculectomy will be occasionaly covered but this is a much abbreviated and different procedure and result from a tummy tuck
Tummy Tucks are not a medical neccesity.
Hi kwrightbigk, A Tummy Tuck is a cosmetic procedure. It is not medically necessary to prevent or treat any illness or condition for a patient to live or even function. Many people are under the false assumption insurance companies will pay for them to have plastic surgery. Many, many moons ago, this would occasionally happened, yes, but healthcare in our country has changed dramatically in the last decade and with the current state of affairs in our government regarding healthcare coverage, I can assure you, no provider is paying for cosmetic procedures. If you are instead referring to a panniculectomy, this is not even close to a Tummy Tuck (Abdominoplasty). A Panniculectomy only removes the large apron of skin and fat that hangs over the pubic area. That's it. It does not address excess fat or loose skin on the rest of the abdomen or hips and it does not repair the muscle wall in the abdomen. Clearly the abdominoplasty offers much more correction and better outcome for most patients, but strangley some insurers still pay for only a panniculecotomy after dramatic weight loss. The benefits paid by insurance companies for plastic surgery vary greatly from carrier to carrier and plan to plan. If you are hoping that your health insurance will pay for your surgery, we recommend checking with them ahead of setting up your consultation. Good luck!
Covered by insurance
A Tummy Tuck (Abdominoplasty) consist in removing excess skin on anterior abdomen with plication of abdominal muscles ( suturing muscles together) this is purely a cosmetic procedure. In some patients, specially in the obese or patients after massive weight loss, the insurances may cover removing only the lower apron that hangs over the Mons. Usually is covered on occasions where there is documented frequent rashes and infections. This only eliminates the lower part and does not change anything with the rest of excess skin or tightening of the muscles.
Insurance and TT
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.