No Insurance Company Will Pay for a Tummy Tuck

I have a PPO.  How can I get my insurance company to pay for a tummy tuck?  Or will I have to pay for it out of pocket?

-Andy in Ventura, California

Dear Andy,

I think that you are confusing 2 separate procedures:

• panniculectomy
• abdominoplasty

A panniculectomy is a functional procedure for removing excess skin and fat.  An insurance company MAY authorize a panniculectomy if...

• The apron of excess abdominal skin impedes walking.
• The apron of excess abdominal skin impedes normal groin hygiene.
• There are recalcitrant fungal infections beneath the skin folds.
• The fungal infections have progressed to bacterial infections, necessitating hospitalization and IV antibiotics.

A panniculectomy is NOT an attractive operation.  The goal is function, not cosmesis.

• There is no tailoring of the skin excess.
• There is no liposuction to contour the flanks.
• The bellybutton is not preserved.
• The muscles are not tightened.
• The abdomen is not optimally flattened.

If your goals are functional, then you should consider a panniculectomy.  Find a Board Certified Plastic Surgeon who accepts your insurance, and then speak with him/her frankly.

If, however, your goals are to have a more attractive torso, then you are looking for an abdominoplasty, better known as a tummy tuck.  An abdominoplasty will take care of everything that a panniculectomy will, but it will also do more....

• The extra skin and fat (that creates the "apron" and/or the "roll") will be removed.
• The skin will be pulled taut, and will be tailored to your frame.
• The bellybutton is reconstructed and rejuvenated.
• The "six-pack" muscles are tightened.
• The abdomen is flattened.
• Often, some liposuction is done on the flanks to optimize the waist.

Obviously, no insurance company is going to pay for you to look cuter.  Medical insurance is supposed to help defray medical expenses.  An unattractive belly is not a medical problem; it is an aesthetic issue.  So, an abdominoplasty would be your financial responsibility.

There is one more caveat:  Sometimes, a patient suffers medical problems from an abdominal "apron."  Moreover, he/she wants not only functional relief but also aesthetic improvement.  In this circumstance, the surgeon can help the patient obtain authorization for a panniculectomy.  The patient might then pay the difference for a full tummy tuck.  In effect, the patient is getting the best of both worlds:  functional improvement (covered by the insurance company) and cosmetic enhancement.  Check out this example below...

 

Comments

[Brandywine Abdominoplasty]

I think that most people would want to have an abdominoplasty: Especially when the reason for having an abdominal apron is due to extreme weight loss. Each successful weight loss story reflects one person's journey from being morbidly obese to being able to go to any clothing store and try on things right off the rack! The aesthetic completion of the panniculectomy procedure is vital in these cases to complete the particular person's vision of the final look.

[Michael Pickart]

Well stated, Brandywine. I wish that I were that eloquent!

Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

428 Poli St.,#2C, Ventura, CA 93001
(805) 648-4567 | fax (805) 641-0811

To: info@pickartplasticsurgery.com
Subject: [Pickart Plastic Surgery Blog] Brandywine Abdominoplasty submitted a comment to No Insurance Company Will Pay for a Tummy Tuck
Date: Thu, 7 Jan 2010 09:14:17 -0800

[tummy tuck]

It would be nice to have tummy tuck procedures covered by insurance. I heard it helps with anemia and low blood pressure. Maybe that will justify coverage?

[captive insurance]

Nothing would justify the coverage of a tummy tuck. Its superficial, the only reason anyone would get it is superficial, and all insurance companies know it. Thems the breaks.

[CAPlastic Surgeon]

I can't see why anyone wouldn't have a tummy tuck after seeing those before and after pictures. Good work Doc!

[Edward Berzin]

Very nice. I want more informative articles like this to help the customer.

[sydney eyelift surgery]

this is quite a nice post, I think that it is important to know about this.

[ClubPenguinCheats]

I heard it helps with anemia and low blood pressure. Maybe that will justify coverage?

[Michael Pickart]

Nope. Unfortunately, neither an abdominoplasty nor liposuction will decrease your blood pressure, help to control your diabetes, lower your cholesterol, etc. Bummer.

Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

1746 S. Victoria Ave., #250, Ventura, CA 93003
(805) 654-8800 | fax (805) 654-8802

To: info@pickartplasticsurgery.com

[Notimportant]

Panniculectomy or abdominoplasty or whatever, I'd be thrilled. I've lost 215 pounds (so far). My apron sits on my legs. It cuts off the circulation of my legs & makes my calves swell & turn purple. I sit for work. So that doesn't help. The apron is heavy and long and pulls my entire body downward. Unfortunately, I do not have insurance. So I'm stuck with the apron & the problems it brings with it. My point to you is aprons cause more than just hygiene issues.

[Michael Pickart]

I totally agree. An apron (medically known as a panniculus) can be a serious problem: hygiene, fungal infections, secondary bacterial infections, diminished ambulation, swelling, etc.

Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

1746 S. Victoria Ave., #250, Ventura, CA 93003
(805) 654-8800 | fax (805) 654-8802

To: info@pickartplasticsurgery.com

[Notimportant]

I forgot to mention another side effect - the weight of the apron causes problems with being able to hold urine.