Hi Kwrightbigk, Hello, Thank you for your questions about when is tummy tuck "medically necessary". This is a very common question. First of all, we need to define four key terms. 1) Panniculectomy: this is a plastic surgery procedure in which the apron of skin hanging over the pubic region is removed. During a panniculectomy procedure, the rectus abdominis muscles are not sutured and the belly button is not repositioned. 2) Tummy tuck: during the tummy tuck procedure, excess abdominal skin and fat from the pubic region to the belly button are removed. The rectus abdominis muscles are sutured together. The belly button is repositioned. 3) Cosmetic or aesthetic plastic surgery procedures: this a procedure that takes a "normal" patient and makes them "super normal" or "more augmented". A cosmetic plastic surgery procedure would include elective breast augmentation. 4) Reconstructive plastic surgery procedures: these plastic surgery procedures take an "abnormal" patients and make them more "normal". Typical reconstructive plastic surgery procedures would include cleft lip, cleft palate, and burn surgery. Insurance coverage for any plastic surgery procedure varies by individual and insurance plan. Sometimes medical insurance plans cover panniculectomies. If the patient has severe rashes which have failed treatment with creams and lotions. In addition, a panniculectomy may be covered by insurance if a patient has severe, low back pain. Insurance plans view a panniculectomy as a reconstructive plastic surgery procedure because it is taking an "abnormal" patient and making them more "normal". It is rare, if ever, that medical insurance plans cover a tummy tuck. Usually, tummy tucks are viewed by insurance plans as being a cosmetic procedure. Sometimes if the patient has severe separation of the rectus abdominis muscles resulting in rectus diastasis, ventral hernia, and excess abdominal skin and fat, the tummy tuck procedure may be covered by insurance. However, insurance plans would view this scenario as reconstructive plastic surgery procedure more than a cosmetic procedure. Again, medical insurance plans do not cover cosmetic plastic surgery procedures. I hope that I have answered your questions regarding panniculectomies, tummy tucks, cosmetic medical insurance coverage, and reconstructive medical insurance coverage. If you have any more questions regarding medical insurance coverage for a tummy tuck or abdominoplasty, please contact my office. Sincerely, Dr. Katzen.