Is Tummy Tuck for Yeast Infection Covered by Insurance?

Question

Are yeast infections enough to have your insurance company pay for a tummy tuck? My primary doctor told me that I could have about 10 pounds of fat removed from my stomach which causes yeast infections, she told me that a Tummy Tuck would be covered by my insurance, is this true?

	I am having no luck in the Boston area to find a surgeon to perform this operation for me. What should I do? I am miserable with myself!

J. Timothy Katzen, MD, FACS · Answer

Dear corjoe222@aol.com,

It's understandable that you're seeking relief from the discomfort caused by yeast infections due to an overhanging pannus. While it's more common for insurance to cover a panniculectomy — a procedure that removes the overhanging skin and fat causing health issues like yeast infections — rather than a full tummy tuck (abdominoplasty), which is considered a cosmetic procedure, insurance coverage can vary greatly depending on your policy and specific health situation.

Panniculectomy addresses the medical concern of skin irritation and infections by removing the excess skin. If a tummy tuck, which also tightens the abdominal muscles and removes excess fat, is something you're considering, some patients have successfully had their insurance cover the panniculectomy portion of the procedure and then paid the difference for the cosmetic aspects of a tummy tuck out of pocket.

It's crucial to consult with your insurance provider to understand the specifics of your coverage. Additionally, if you're finding it challenging to locate a surgeon in the Boston area willing to undertake your procedure with insurance, consider expanding your search. Many plastic surgeons offer virtual consultations, which can significantly broaden your options and help you find a surgeon experienced in navigating insurance for these types of surgeries.

I wish you the best in finding a solution that brings you relief and satisfaction. It's unfortunate to hear about the discomfort you're experiencing, and I hope you find a qualified plastic surgeon who can assist you in improving your quality of life.

Sincerely,

Dr. Katzen
Plastic Surgeon

Lewis Albert Andres, MD · Answer

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.  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!

Otto Joseph Placik, MD · Answer

Dr. Brzowski has an excellent response and I would agree.
A tummy tuck is typically a combination of a panniculectomy, muscle repair, and commonly, liposuction. A full tummy tuck treats the skin and muscle above and below the umbilicus.
A panniculectomy typcially removes only the lower abdominal skin which hangs over.
In any event, the best way to determine insurance coverage is to submit a predetermination letter of benefits to your insurance carrier with supporting documents from your internist. This letter is most commonly written by the plastic or general surgeon. Photographs can be helpful.
Call around for surgeons who are willing to perform this service. Typically, there will be a fee or bill generated.

Steven M. Lynch, MD · Answer

Hi,

	  It is variable as to how the insurance companies cover or do not cover pannus excisions or tummy tucks.  It would be more rare for an insurance company to cover the full tummy tuck and it would be equally rare to find a good qualified plastic surgeon who would do the full deal under your insurance plan.

	  Some companies cover the pannus excision. If that is all you need, either a general surgeon or a plastic surgeon can handle it.  It is merely cutting off the tissue that is hanging down and touching the lower tissues giving you the yeast infections.  If that is all you want, then call your insurance company and see how they want to handle it.

	 If it is more of a body contouring (beyond the pannus excision), then you need to talk to a plastic surgeon about the muscle tightening etc. 

	              Steven M. Lynch, M.D.

Steven Wallach, MD · Answer

Each insurance carrier has different criteria for pre-approval of a tummy tuck and rashes.   It is almost never covered. You should check with your insurance carrier.

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