Why are tummy tucks for weight loss patients paid for my insurance but not for women who have been pregnant?

You choose to be overweight, you also choose to be pregnant. Most women who have been pregnant work very hard to trim down and look at surgery as a last option. Some are even left with very deformed stomachs after giving birth. I'd like to understand why one is so different from the other?

Doctor Answers 8

Abdominboplasty is a cosmetic procedure and it is not covered either for weight loss nor pregnancy

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From our experience most insurance companies will not cover full abdominoplasty procedure. It is a cosmetic procedure-not a covered benefit.
Some insurance companies will cover penniculectomy. Panniculectomy is "a surgical procedure used to remove a panniculus, which is an apron of fat and skin that hangs from the front of the abdomen. In certain circumstances, the panniculus can be associated with skin irritation and infection due to interference with proper hygiene and constant skin-on-skin contact in the folds underneath the panniculus. The presence of a panniculus may also interfere with daily activities. Panniculectomy is covered only when certain, very specific medical criteria are met. However, in some cases these procedures can be combined - panniculectemy with abdominoplasty

Tummy tucks covered by insurance

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The reason is that medical problems like rashes and infections can develop under very deep skin flaps , like after massive weight loss. Truth is, though, most insurances dont cover this anymore either.

Tummy tuck and insurance

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The reason behind this is that many individuals who have massive weight loss develop sores and rashes underneath their stomachs. This would be uncommon after just gaining and losing weight with pregnancy.

Their skin is looser

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Most insurance companies have strict criteria for covering a portion of the abdominoplasty procedure as medically necessary. They cover the excision of the overlapping skin, which is called panniculectomy. I have reviewed cases for a number of insurance companies and most have criteria that include

1.the abdominal pannus (overlapping skin) hangs at least over the vulva (pubic area),

2.the patient have documented lower back pain being treated by an orthopedic surgeon or chiropractor for over a year, and

3.have a rash in the under fold of skin that has been under a physician's care for over a year. Most patients post-pregnancy don't meet these criteria.

Panniculecotmy not a cosmetic operaiton

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I agree with the excellent explanation Dr. Becker gave. Insurance never pays for cosmetic operations. If a woman has the type medical problems that Dr. Becker described, her medical insurance might pay for a panniculectomy to correct or relieve the medical problems. The cosmetic improvement from the panniculectomy is a secondary benefit of the panniculecotmy, but not the reason the insurance will pay for the surgery. T

Insurance companies will only pay for a panniculectomy when there is a very large apron of skin and fat that hangs down. This type of problem is virtually never seen following pregnancy.

John J. Bandeian, MD
Bristol Plastic Surgeon

Rarely covered

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abdominoplasties are rarely covered after weight loss surgery. Occasionally with excellent documentation of severe infection or recurrent rashes that are resistant to conservative management- they may cover a panniculectomy which only removes the lower abdominal excess. Many gastric bypass patients are disappointed to find this out but that is the reality

Glenn Lyle, MD
Raleigh-Durham Plastic Surgeon

Insurance coverage for tummy tuck

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There are certain problems which arise following pregnancy or significant weight loss. There is hanging skin below the belly button (this is called a panniculus), there is loose, or hanging, skin above the belly button, and the muscle wall of the abdomen is loose and protrudes forward. A traditional abdominoplasty (tummy tuck) corrects all three of these problems. However, none of these problems ordinarily cause functional issues and therefor insurance companies do not consider their correction medically necessary and do not cover the surgery. This is true whether the problems have occurred following pregnancy or weight loss.

The exception is in some patients who lose a lot of weight (usually 100 pounds or more). In some of these patients, the lower abdominal hanging skin (the panniculus) is so large, and hangs so low (mid-thigh or even lower!), that there are functional problems such as skin infections and skin breakdown, difficulties walking, etc.. In these cases (which are not that common) the insurance company will pay for a panniculectomy. The lower hanging skin will be removed, but the problems of loose skin above the belly button and a loose muscle wall are not addressed.

William A. Terranova, MD
Charleston Plastic Surgeon

Abdominoplasty for Weight Loss Patients

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"Tummy Tucks" are not covered by most insurance companies; weight loss or not. A panniculectomy may be if it meets certain requirements, which vary from company to company but usually involves a history of rashes despite conservative treatment and skin that extends below the pubis. A panniculectomy is not a tummy tuck; the belly button is not moved and the skin above the belly button is not addressed. It is very common to confuse the two, but they are very different operations.

I hope that eases some of your frustration.

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.