Is tummy tuck for yeast infection covered by insurance?
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
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!
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.
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.
Tummy tucks are not covered by insurance, but a panniculectomy might be covered
A tummy tuck addresses fat and skin in the upper and lower abdomen, and it includes tightening of the muscles in the abdomen. A tummy tuck is always cosmetic in nature and never covered by insurance. A panniculectomy is removal of lower hanging abdominal skin. If you meet your insurance company's criteria, a panniculectomy would be covered. Most insurers require a pannus (hanging skin) of a certain size (such as hanging below the level of the pubic bone or to mid-thigh--it varies by insurer). They also typically require documentation of skin problems, such as your yeast infections, which are recurrent despite adequate treatment. You'll need to check with your own insurance, or have your plastic surgeon's office check for you, and find out your insurance company's specific requirements for coverage of panniculectomy.
Tummy Tuck and Insurance coverage
Regarding: "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!"
Your Primary Care doctor is wrong. Non-Plastic surgeons, including Primary Care physicians, are often confused by the multiple operations aimed at flattening part or all of the belly. Here are the operations likened to and confused with a Tummy Tuck (Abdominoplasty)
PANNICULECTOMY (Apron Resection) - Removes the skin overhang / skin fold to allow better hygiene of the area below. Does NOT remove all the loose tummy skin, does not tighten the muscles, does not transpose the belly button and does NOT flatten the tummy and narrow the waist. IT IS NOT A TUMMY TUCK. SOME insurance company may pay for this operation. THIS is the operation your Primary care was confused about.
MINI - Tummy Tuck - Treats ONLY the tummy BELOW the Belly Button. Does NOT remove all the loose tummy skin (ONLY that below the belly button), may involve tightening the muscles below the belly button, does not transpose the belly button, does NOT flatten the entire tummy. IT IS NOT covered by ANY insurance companies.
(Full, Standard) Tummy Tuck or Abdominoplasty - is a Cosmetic Surgery in which ALL the loose tummy skin is removed, the whole length of the tummy muscles are tightened, the belly button is transposed, the tummy pooch is flattened and the waist is narrowed. This operation is NEVER paid for by any insurance company and attempting to pass such charges to them would constitute insurance fraud.
Your options are either to find a surgeon who will perform an insurance covered panniculectomy, have it done at a Plastic Surgery training program, have weight loss surgery followed by a self-financed Tummy Tuck.
Dr. Peter Aldea
Insurance coverage for tummy tuck
There are many options to re-contour the abdomen. If you have a great deal of abdominal fat and skin and are developing infections in between the folds of skin, you may benefit from a panniculectomy. This is a procedure where the extra skin and fat is removed but no muscle repair is performed. It is possible that this surgery will be covered by your insurance plan. Your best bet is to be evaluated by a board-certified plastic surgeon was a great deal of experience in abdominoplasty and body contouring techniques. They will be able to evaluate your skin and tissue and help you decide which option is best for you.
To learn more about tummy tucks, see photos, and help you decide which one is best for you, please visit us at the link below:
Write a letter to your insurance company to determine benefits
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.
Tummy Tucks are NOT covered by medical insurance
Because a tummy tuck is a cosmetic surgical procedure, medical insurance companies do not cover the costs involved. Having said that, the problem with yeast infections beneath the skin folds is a medical problem. Treatment for this condition would typically be covered by your medical insurance. The surgical option for treatment of this situation is a different procedure called a panniculectomy.
A panniculectomy is a procedure that only removes the skin fold along the lower abdomen. While this generally results in elimination or improvement of the rashes, it is NOT a tummy tuck. A tummy tuck will remove the majority if not all of the loose abdominal skin as well as tighten the separated muscles. It does much more to flatten your abdomen and has the added effect and benefit of helping rid you of the troublesome rashes. A tummy tuck is more complex and lengthy, and should not be confused with the more limited panniculectomy.
As you look for a plastic surgeon to perform your procedure, be sure that you are seeking the correct procedure. Make certain that you explain what it is you are trying to achieve. If you wish to undergo a tummy tuck instead of a panniculectomy, don't expect your insurance to cover the procedure or ask your plastic surgeon to bill them for it-----it's a cosmetic procedure:)