Should my procedure be covered by OHIP? I'm 47 years old, I've had a Hysterectomy in 2009.

My tummy did not recover since and I have excess skin in my lower abdomen which never went away even with exercise and dieting, and still I can feel pain and itchiness in the incision, should the removal of this excess skin be covered by OHIP??

Doctor Answers 3

Should my procedure be covered by OHIP?

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If the scar is painful or bothersome, insurance will sometimes cover that. But a full TT? That is always cosmetic and never covered by insurance.

Tummy Tuck - Insurance Coverage?

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Thank you for your question. Insurance companies typically view excision of excess skin as not medically necessary. Therefore, it is not a covered procedure. Please see a board certified plastic surgeon for an in-person examination. Your surgeon could potentially contact your insurance company if you have documented rashes or fungal infections secondary to your skin excess. Hope this helps!

It is not up to me to make that determination

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Whether or not your surgery would be covered is entirely up to your insurance company.  Typically, from the way you describe your situation, it would not be covered.  Your insurance company "doesn't care" if you have excess skin.  Have your plastic surgeon write a letter to your insurance carrier and ask for "prior approval."  Once again, even prior approval from an insurance company does not guarantee payment, but it is a step in the right direction.  Good luck.

Elliot Duboys, MD, FACS
Long Island Plastic Surgeon

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.