When is Tummy Tuck Medically Neccessary?

When would a tummy tuck be medically neccessary? Cosmetic surgery would not be covered by insurance, only if medically needed.

Doctor Answers 21

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.

Los Angeles Plastic Surgeon
4.0 out of 5 stars 8 reviews

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.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 64 reviews

Tummy tuck and insurance

It has been my experience that the only procedure that insurance will cover is a panniculectomy. That is removal of the overhanging skin and fat from below the belly button. They cover that whn a patient has symptoms of uncontrolled rash and infection and well as hygeine problems. All else is generally considered as cosmetic.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 24 reviews

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.

Nina S. Naidu, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 6 reviews

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.

Good luck.

Andrew T. Cohen, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 25 reviews

When is tummy tuck medically necessary?

By definition, tummy tuck is never medically necessary. If you have symptoms related to a large flap of skin hanging over your legs (a "pannus") then this is sometimes covered by insurance, but it is called a 'panniculectomy' and is not a cosmetic operation.

Bryan Correa, MD
Houston Plastic Surgeon
5.0 out of 5 stars 7 reviews

Tummy Tuck And When It Can Be Medically Necessary

Tummy tuck is considered a cosmetic procedure. It is rarely a medical procedure. The only time it may be medically necessary is when the redundant abdominal wall skin are so much that frequent skin infection happen.

Colin Hong, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 32 reviews

Tummy Tuck

In my experience, general surgeons would have more experience dealing with panniculectomies. That is a procedure that may be covered by insurance. 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 84 reviews

When is tummy tuck medically necessary?

Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.  There is a difference between a tummy tuck, which is purely cosmetic, and a panniculectomy.

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 16 reviews

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.