When is a Body Lift Covered by Insurance?

The term "Body Lift" refers a cosmetic procedure that is generally not covered by insurance. Other surgeons have described insurance coverage criteria.

Hope this helps

Nick Slenkovich MD, FACS

Dear Eva:
  I have had significant success having body lifts covered by insurance.  The insurance coverage completely depends on your resulting skin excess, medical comorbidities, and your insurance plan. 
Typically, insurance companies cover body lifts if you meet certain criteria which can include skin rashes which do not go away after treating them with creams and lotions for over three months.  Typically, these rashes occur in the pubic region, saddle bag region, and in the buttock region. 
Criteria that are also required for body lift coverage include excess skin and fat that covers the pubic region.  Different insurance plans have different requirements, however most insurance companies required skin and fat completely cover the pubic region. 
Other criteria include difficulty keeping the pubic region clean and chronic skin ulcers both in the pubic region and in the buttock region.  Other conditions that help document the need for insurance coverage include low back pain. 
Often, I have patients obtain letters from their chiropractor, orthopedic surgeon, or spine surgeon indicating that removal of excess skin and fat of the lower torso would reduce the strain on the patient’s low back, hips, and ankles.  I have also had body lifts approved for patients with significant knee problems requiring knee replacements for the sure fact of removing excess skin and fat and thus reducing the amount of weight on a person’s knees.  Criteria that I also mentioned for insurance coverage include if indicated difficulties with intimacy due to excess skin and fat.
 
  It should be stated clearly; however this cannot guarantee that your insurance company will approve your body lift.  However, these are items which can maximize the potential for insurance coverage.  Please do not hesitate to call my office to schedule a phone interview and visit my website for before and after pictures.
Thank you,
_________________________
J. Timothy Katzen, MD, FACS

Thank you for your question about coverage criteria for a body lift.  Bariatric surgery is typically covered by insurance carriers unless it is excluded because it is effective in creating weight loss and improving co morbities such as hypertension, diabetes and knee problems.  Despite the strong science in this regard, not all carriers cover the surgery because of the cost...this is called a policy exclusion.  Similarly aesthetic body contouring procedures such as a body lift can not only improve your body image and quality of life but also help to keep the weight off permanently.  Despite these benefits, most carriers exclude most aesthetic procedure such as body lifts.  If aesthetic procedures are excluded as a covered benefit, they will not be covered under andy circumstances.   In some cases they are not excluded as a covered benefit, but must meet medical necessity.  Meeting medical necessity is intentionally vage and difficult to ascertain.  Insurance companies typically do not make this process transparent or efficient.   The most effective approach would be for you to reach out to your insurance carrier to get the information directly from them as it may vary by carrier,  Since you are their customer, they are more likely to be responsive to you than they are to your surgeon.  The first question to ask is whether a body lift is a covered benefit under your plan.  If it is a covered benefit, then I would ask what are the medical criteria and documentation necessary to meet medical necessity.  I would ask them to send you this information in writing.  Thereafter, I would go about scheduling the doctors appointments necessary to fullfill those criteria if possible.  Once that process has been completed, then you are ready to seek consultation with a board certified Plastic Surgeon.  I hope this helps!  Best wishes on your weight loss journey.

Most elective surgery is not covered by insurance, of course, but there are a few instances  (breast reduction, for example) when it might be determined to be medically necessary or reconstructive.
The only part of the body lift ( TT + outer thigh lift + posterior body lift)  that would possibly be covered is the panniculectomy (excess skin) part of the tummy tuck. It is best to have your primary care physician document any issues you are having (skin infections, fungal infections, rashes, etc.) and look at your insurance policy details (or speak to an agent) to determine what they might cover and what clinical criteria they use. Deciphering what is, and what is not, covered by insurance can be tricky when it comes to elective / reconstructive surgery. Nearly all cosmetic surgery is not covered.
It also doesn't hurt to consult with a board certified plastic surgeon to discuss your concerns and determine what procedure would be able to offer you some relief as well (whether it would be covered by insurance, financed, or saved up for).
Best wishes!

It's not unusual for massive weight loss patients to develop significant amounts of redundant truncal skin. A variety of surgical options are currently available to address these problems. These include both panniculectomy and body lift procedures. The choice of procedure is dependent upon the patient's anatomic findings and aesthetic goals.It would be extremely unusual for an insurance carrier to cover the cost of a body lift procedure. Most insurance carriers would view this procedure as cosmetic in nature.In contrast, abdominal panniculectomy may occasionally be covered by insurance companies if hanging skin is associated with functional problems. Under these circumstances, back pain, rashes and severe infections related to hanging skin may lead to insurance coverage.It's important that each patient be considered individually when undergoing this type of procedure. It's, therefore, important to consult a board certified plastic surgeon. This surgeon should be able to determine what type of procedure will meet your aesthetic goals and whether or not it will be covered by insurance.

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In my experience, rarely is/are any cosmetic portion of body contouring procedures going to be covered by a third party payor.  In selected cases, a panniculectomy may be covered, but this is not a cosmetic procedure, and will not address loose skin around the posterior or lateral portions of your torso..  

Most of the time insurance does not cover body lifts.  If it is a covered benefit, insurers would typically require abdominal skin hanging below the pubic bone, severe rashes and skin infection history, and functional impairment caused by the skin.  

Hello, and thank you for this question. We have found that in the past 10 years it is more and more difficult to get any insurance coverage for body reduction surgery. Many policies have specific explanations regarding body reduction procedures. insurance covers

INSURANCE NORMALLY DON’T COVER PLASTIC SURGERY. FOR PATIENTS WHO HAS MEDICAL CONDITIONS DUE
TO THE EXSESS OF SKIN IN SOME CASES THEY COVER. A GOOD ALTERNATIVE IN MEDICAL
TURISM THAT MAKE AFORTABLE THE RECONTRUCCION

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. 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!