How to get insurance to pay for a tummy tuck

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People are familiar with the term tummy tuck or abdominoplasty. It’s a cosmetic surgery that can give you a more toned and flatter stomach.

You may be considering this reconstructive procedure if you have stretched out skin in your abdominal area after having a few children or losing significant weight through diet, exercise, or weight loss surgery.

A tummy tuck is an elective procedure that costs around $6,200 on average. If you’re thinking of getting one, you’re probably wondering if your insurance will cover the procedure.

Does Insurance Cover A Tummy Tuck Procedure?

In general, a tummy tuck is a cosmetic procedure that’s not covered by most insurance plans. But there are instances when insurance companies may be able to make an exception.

Your insurer may cover part of the costs if the procedure is medically necessary, such as when excess skin is causing health issues like skin rashes or infections.

The tummy tuck procedure is divided into two phases. The abdominal muscles are tightened in the first phase while the second phase involves the removal of the excess skin and tightening of the remaining one on your abdominal area.

If a tummy tuck is considered medically necessary, your insurer may cover only the second phase of the procedure. 

The removal of the excess skin can help prevent skin problems while the tightening of the abdominal muscles only serves cosmetic purposes.

Therefore, you’ll be responsible for covering the costs of the first phase of the procedure.

When Is A Tummy Tuck Considered As Medically Necessary?

A tummy tuck may be considered medically necessary to treat the following health conditions:

  • Ventral hernia
  • Stress urinary incontinence
  • Chronic back pain
  • Inability to walk normally
  • Skin folds causing ulceration and chronic pain
  • Large skin fold (panniculus) hanging below your pubic area

Tummy Tuck vs Panniculectomy: Which is more likely to be covered by Insurance?

Panniculectomy and abdominoplasty, also known as a tummy tuck, are similar procedures that involve the removal of excess skin on the lower abdomen. They are generally performed for patients who have lost a lot of weight through natural or surgical procedures, such as gastric bypass.

Both surgical procedures target lower belly skin. However, they also differ in certain aspects.

Tummy Tuck

A tummy tuck removes excess skin and tightens abdominal muscles for cosmetic purposes. It’s an invasive procedure that is elected generally for aesthetic reasons and not because it’s medically necessary, which disqualifies it from being covered by insurance companies.

Panniculectomy

A panniculectomy is an invasive surgical procedure for people who have large amounts of excess skin on their lower belly. It’s performed when the excess skin and tissue in your lower abdomen negatively affect your health, like when you develop rashes, ulcers, or infection in the skin folds.

Unlike tummy tucks, panniculectomy doesn’t tighten the abdominal muscles. It’s not elected for cosmetic purposes but to correct health issues caused by the excess skin.

Since it’s generally medically necessary, panniculectomy has a higher chance of getting covered by insurance companies compared to a tummy tuck.

Do Insurance Companies Cover Panniculectomy?

The cost of this procedure ranges from $8,000 to $15,000, which already includes the facility fees, surgeon costs, and fees for anesthesia. If panniculectomy is seen as a medical necessity for you, your insurance provider may help you pay for the procedure.

Get in touch with your insurance company to confirm if they’ll cover the surgery and if not, ask about your payment options.

How Can You Get Tummy Tuck Approved By Your Insurance Company?

While most health insurance doesn’t cover tummy tucks, there are some things you can do to increase your chances of getting coverage.

  • Talk to your primary care physician and ask if you can get a tummy tuck and have it covered by your insurance.
  • Have a routine check-up. Let your doctor check your lower abdomen and determine if you’re a good candidate for a tummy tuck or panniculectomy.
  • Explain to your doctor why you’re thinking about having a tummy tuck – the reasons should be that it is medically necessary.
  • Explain any health problem that you may be experiencing because of your tummy, particularly the excess skin and the loose abdominal muscles.
  • Tell your doctor if you’re experiencing ulcerations, rashes, and infections in the skin fold in your lower abdomen.
  • Let your doctor check for umbilical or ventral hernia. Both conditions may require a tummy tuck procedure to fix it. Since it’s medically necessary, your insurance provider may cover your expenses.
  • Call your insurance company and ask if there are certain cosmetic surgeons that they may be willing to provide coverage if your tummy tuck surgery is deemed medically necessary.

How To Get Medicaid To Cover Tummy Tuck?

Medicaid covers life-sustaining operations, such as removing malignant tumors. It usually doesn’t cover elective surgeries, like tummy tuck, unless they’re medically necessary.

If you need a tummy tuck and want Medicaid to cover it, you have to prove that it addresses a health condition or have it performed together with a covered procedure, such as panniculectomy, hernia repair, or hysterectomy. 

What Is Diastasis Recti And Is It Covered By Insurance?

Another procedure that’s similar to a tummy tuck is called diastasis recti repair. It’s an option for women who suffer from diastasis recti after pregnancy or childbirth.

Diastasis recti is a condition wherein the abdominal muscle separates from the midline of the rectus abdominis muscle, which causes the stomach to protrude after pregnancy.

A diastasis recti repair procedure involves suturing the abdominal muscles together to improve the contour, appearance, and function of the abdominal wall. It can be performed together with a tummy tuck.

The cost of the procedure depends on various factors, such as the location and the surgeon who’ll perform the procedure. But the average price range is anywhere between $5,000 and $19,000.

Just like abdominoplasty, a diastasis recti repair is generally not covered by insurance because it’s considered cosmetic and not medically necessary. Insurance companies may pay for it if a diastasis recti surgical repair needs to be done to correct a hernia.

Conclusion

A tummy tuck, or abdominoplasty, is a popular surgical procedure for people who wish to have firmer abdominal muscles and get rid of excess skin on their lower abdomen after losing a lot of weight or having a few children.

This procedure is considered cosmetic, which is why most insurance companies don’t cover them. But if the procedure is deemed medically necessary, then your insurer may help pay for it.

Such is the case with a panniculectomy, which involves the removal of excess skin from your lower belly to prevent problems like rashes, infections, ulcerations in the skin folds, and more.

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