Tummy Tuck: Prices, Photos, Reviews, Info, Q&A

Tummy tuck and medical necessicity

A tummy tuck may be medically necessary if the skin overhangs to such a degree that chaffing and chronic dermatitis and infections result underneath and do not heal.

However, you should contact your insurance carrier because not all consider surgery as a treatment at any time and may not pay for it. (Ricardo Izquierdo, MD, Oak Brook Plastic Surgeon)

The answer is never. Tummy tuck is by definition, a cosmetic procedure.

Lesser procedures like panniculectomy may be an insurance covered procedure – it includes removal of skin and fat, but no muscle tightening.

Medically necessary abdominoplasty

Still, that would be dicey too, depending on your particular coverage. (Scott E. Kasden, MD, Dallas Plastic Surgeon)

When is a tummy tuck medically necessary?

A tummy tuck can be covered by insurance and we have had good luck in patients that have lost much weight. The insurance companies criteria varies but they look at rashes, difficulty ambulating.

We try and send pictures, write letters and help with the review process. (Edward J. Domanskis, MD, Newport Beach Plastic Surgeon)

Tummy Tucks rarely medically necessary

Medically necessary tummy tuck opeartion

Insurance does not always cover everything that might be considered necessary in a medical sense, and procedures that are most often done for cosmetic reasons sucha as abdominoplasty are particularly problematic for them. It’s easier just to deny coverage for such procedures categorically rather than on a case-by-case basis.

When they do cover it, there would need to be clear evidence that the condition is causing significant medical problems not correctable without surgery, and this is rarely the case with tummy tucks. (Richard Baxter, MD, Seattle Plastic Surgeon)

Defining “Medical Necessary” for Panniculectomy – “Tummy Tuck”

Thanks to the medical insurance companies and Medicare / Medicaid the English language has undergone an Alice in Wonderland like transformation. I’ll give you a few examples:

Medically necessary tummy tuck surgery

– ELECTIVE surgery – surgeon and / or patient choose the TIME / place of surgery (opposite of EMERGENT surgery (such as burst appendix, stab to heart) when one needs to be rushed to the OR)

– COSMETIC surgery – a component of Plastic Surgery in which we operate on NORMAL people to improve their appearance

– RECONSTRUCTIVE surgery – the other component of Plastic surgery in which we restore people (from losses by disease, trauma, cancer surgery or birth defects) to as close to normal appearance as possible.

– EXCLUSIONS – Medical services that are not covered by an individual’s insurance policy. The VAST majority of Cosmetic surgery procedures ARE excluded.

The medically necessary tummy tuck

– Insurance COVERAGE – subject to verification and re-verification that said disorder / operations (IE COVERED CHARGES) are SPECIFICALLY listed under your individual insurance policy (contract), your insurance MAY pay PART of the cost of the treatment / surgery as outlined in your policy subject to DEDUCTIBLES, CO PAYMENTS etc

– PRECERTIFICATION / PROSPECTIVE AUTHORIZATION – Insurance company permission to deliver health care service that is issued before any service is rendered but WITHOUT an obligation on their part to pay.

– MEDICALLY NECESSARY – Many insurance policies will pay only for treatment that is deemed “medically necessary” to restore a person’s health which is not primarily for the convenience of the plan member or a doctor. For instance, many health insurance policies will not cover routine physical exams or plastic surgery for cosmetic purposes.

Medically necessary tummy tuck operation photo

A Tummy Tuck will never fall under the definition above and as health care dollars are rapidly shrinking and reconstructive operations are increasingly denied, there is NO chance that this will change. Depending on your policy, if you have a large skin overhang with frequent rashes and skin infections, your policy MAY “cover” a PANNICULECTOMY the removal of the skin overhang.

This is NOT a Tummy Tuck (which involves a much larger undermining and skin removal with muscle repair and movement of the belly button). If you REALLY want to see Health Care premiums go down – tell your congressman / Senator and everyone to vote for the repeal of the McCarran-Ferguson Act – enacted by Congress in 1945 which exempts insurance businesses from federal commerce laws and delegating regulatory authority to the states.

The medically necessary tummy tuck

This stupid federal act placed the primary responsibility for regulating health insurance companies and HMOs that service private sector (commercial) plan members at the state level. A PERFECT way for politicians to benefit from kick backs while we all pay higher premiums. (Peter A. Aldea, MD, Memphis Plastic Surgeon)

Tummy tuck never medically necessary.

After extreme weight loss, people can develop a big roll of hanging skin over their groins. Removing this (panniculectomy) is medically necessary. But a regular tummy tuck is not. (George J. Beraka, MD (retired), Manhattan Plastic Surgeon)

Medically necessary tummy tuck image before and after

Tummy Tuck is NEVER medically necessary

NEVER. Tummy tuck is a cosmetic procedure. Panniculectomy (removal of excess skin after large weight loss) can sometimes be covered in extreme cases where the skin is causing repeated infections, cancer, or some other health problem that cannot be managed otherwise. (Armando Soto, MD, FACS, Orlando Plastic Surgeon)

Tummy Tuck never covered by insurance

Cosmetic Surgery is NEVER covered by insurance no matter how you want it to be. IT IS NOT! Fraud to an insurance company is a felony and loss of the MD license. Please be careful. (Darryl J. Blinski, MD, Miami Plastic Surgeon)