I would like to know what are the odds of my insurance paying for an Abdominoplasy after major weight loss?

On November 4th, 2013 I had RNY. My SW: 288 CW: 174 and I'm 5'5". I have lots of skin hanging on my belly, arms, and thighs. My breast are really saggy and I find all this sagginess is like weighing me down. I find myself drooping over often while walking and off balance. I have noticed in the past month my neck, shoulders, and upper back have been killing me. Not to mention headaches. This use to never be a issue. I also have skin rashes and infections under every fold.

Doctor Answers 4

Most cover panniculectomy

Congradulations on the outstanding weight loss and getting into shape. Removal o fth excess skin is well worth it and will make you feel even better and gain further mobility to obtain the body you want. Most insurance companies require extensive documentation including photos, BMI, weight loss amount and a history of rash in the fold under your pannus. After review, panniculectomy is typically covered (skin excision without umbilicus relocation). Very rarely, a full abdominoplasty or a belt lipectomy (circumferential torso skin excision) will be covered. Skin excision from the arms or thighs after weight loss are usually not covered except in extreme cases of severe rash and folliculitis and insuraance companies want medical record and photographic evidence. Al of these procedures are difficult and can have complications. Make sure to see a board certified plastic surgeon for consultation.

Santa Barbara Plastic Surgeon
4.8 out of 5 stars 17 reviews

Insurance Coverage for Tummy Tuck?

It depends on your insurance company.  Typically, they may cover a panniculectomy (just removing hanging skin) but not an abdominoplasty (tightening the muscles and repositioning the upper abdominal skin.  Having said that, your surgery was just about 6 months or so ago.  Be sure you are at or near your goal weight, and be very careful to follow your physicians prescriptions for vitamins, etc.  The RNY can result in some vitamin deficiencies which could get in the way of healing from plastic surgeries.  Best of luck!

James N. Romanelli, MD, FACS
Long Island Plastic Surgeon
4.6 out of 5 stars 23 reviews

Does insurance cover panniculectomy?

Unfortunately, no unless you demonstrate rashes that are refractory to up to a year of antibiotic treatment, including IV administration.  The other issues you raise are subjective and insurance companies will deny on these grounds.  Congratulations on the incredible weight loss.  Given the amount that you have lost, you are in much better shape than many patients I have seen.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 reviews

Insurance coverage for post bariatric surgery

Each insurance company is different sorry to say. You have a wonderful result from the weight loss procedure and would get a wonderful result from the tightening procedures. The insurance companies sometimes will cover the procedure if due to rashes, or a hernia is present. If not, look for a plastic surgeon who performs these procedures regularly. Usually trying to perform multiple procedures as a team which can be performed totally safely and be cost effective. Good luck.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 22 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.