Tummy tuck covered by insurance
How can I get insurance company to cover tummy-tuck?
Despite the fact that you could certainly have physical benefits from this surgery, such as reduced back pain, insurance companies consider this a cosmetic procedure.
It is very unlikely you will get them to cover it.
We see this all the time with our patients who have undergone weight loss, either on their own or after operations such as gastric bypass.
If you have rashes in the skin folds that do not respond to medical therapy, this may sometimes convince the insurance company to cover the procedure but this is rare.
The tummy tuck covered by insurance
If you want to pursue it, I suggest getting letters from orthopedic surgeons, neurologists and chiropractors that support the claim that the back pain is from the weight of the excessive abdominal skin and/or rectus diastasis.
You can submit these letters to your insurance company. You can also see if there is an insurance specialist in your area who can help you deal with the insurance company.
It is possible your local plastic surgeon would know someone who does this. This would obviously cost you some money. There are many patients in the same situation across the country. (Tracy Pfeifer, MD, Manhattan Plastic Surgeon)
Insurance coverage for abdominoplasty
Tummy tuck covered by insurance images
Insurance companies have various criteria for deeming your condition severe enough and the surgery medically necessary. Obvious signs are frequent rashes requiring treatment, ulcerations of the skin, and infections (cellulitis) caused by open sores. It sounds as if this surgeon is not interested in doing the procedure recommended under an insurance plan.
I would contact your insurance plan and check their criteria. Sometimes this is published on the internet. Consult with other plastic surgeons who might be more sympathetic to your needs. You might be approved for a panniculectomy but not a full abdominoplasty so if some of your goals are cosmetic, you might have to work the combination out with your surgeon. (Robin T.W. Yuan, MD, Beverly Hills Plastic Surgeon)
How to Convince Insurance Company to Cover Tummy Tuck
Tummy tuck covered by insurance photo
Abdominoplasties are not covered by insurance and it is a waste of time to request that they consider it. This is a purely cosmetic procedure and should always be treated as such. (Paul Vitenas, Jr., MD, Houston Plastic Surgeon)
Panniculectomy can be a covered procedure by your insurance company and you need to check with them for what criteria they follow. Often there has to be documented problems with the skin, limitation of activity and failure of conservative management.
The key is to have physician documentation for a year or more. Panniculectomy only removes the apron of skin and does nothing to contour the upper abdomen which is considered cosmetic. (Christopher J. Kovanda, MD, Minneapolis Plastic Surgeon)
Convincing insurance companies for tummy tuck coverage
Tummy tuck surgery covered by insurance
As the consensus shows the insurance companies do not offer cosmetic surgery coverage. If you have an abdominal hernia than part of the surgery can be covered. But you need a hernia general surgeon to evaluate and do an ultrasound or sonogram or MRI of the abdomen. This adds to your costs. (Darryl J. Blinski, MD, Miami Plastic Surgeon)
We have not had an insurance company cover abdominoplasty in over 15 years.
Tummy tuck surgery covered by insurance picture
In drastic cases of hanging skin/fat, there will be ulcerations and infection. In those rare cases (with photo proof of the ulcerations), the insurance company may allow removal of the lower portion of the hanging skin, but leave the upper abdomen/stretch marks/cosmetic aspects completely out. (Francisco Canales, MD, Santa Rosa Plastic Surgeon)
