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 23

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
3.9 out of 5 stars 9 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
4.9 out of 5 stars 81 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 15 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 33 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
4.7 out of 5 stars 13 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 42 reviews

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.

Roberto Gonzalez, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 6 reviews

Insurance and TT

Unfortunately, insurance does not cover a tummy tuck. Occasionally with documentation of recurrent infection they will pay for a panniculectomy (simply removing loose skin).

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 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
4.8 out of 5 stars 118 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.