How To Get Insurance To Cover Tummy Tuck

If you want your insurance company to cover a tummy tuck surgery, it’s important to understand how they decide whether a procedure is medically necessary. That way, you can help them see how your tummy tuck procedure could actually benefit your health in the long-run.

In this guide, we review How To Get Insurance To Cover Tummy Tuck, what insurance covers panniculectomy, how to get insurance to pay for skin removal on arms, and does ppo insurance cover tummy tuck.

How To Get Insurance To Cover Tummy Tuck

Tummy tucks are no longer just an elective surgery for celebrities. It’s a common procedure that’s now being covered by insurance companies as an option for some patients. The question is, how do you get your insurance company to cover it?

When Is Tummy Tuck Covered By Insurance?

There are a few different situations in which tummy tuck insurance coverage is possible.

• You can get insurance to cover a tummy tuck if you have had an abdominal surgery, such as gall bladder removal or hysterectomy, that required the use of a skin graft.
• You can also have your insurance company pay for your tummy tuck if it is deemed “medically necessary.” This means the procedure was required to treat complications from another condition and/or resulted in scarring that left you with undesirable side effects like excessive stretch marks on your abdomen.
• Finally, some people whose weight has fluctuated dramatically may be eligible for cosmetic procedures like tummy tucks by virtue of their new body shape—but this does not mean all such procedures will be covered by their medical plans.

How Do I Get Insurance To Pay For A Tummy Tuck?

The first thing to do is contact your insurance company. You’ll want to ask them whether or not they cover plastic surgery, and if so, what kind of procedures are covered. You should also ask for a referral to a surgeon in the area who performs tummy tucks and any other procedures you may be interested in having done (depending on your insurance plan).

If you are denied coverage, there are two ways that you can appeal: 1) by filing formal paperwork with the insurance company explaining why this procedure would be beneficial for your health; or 2) going directly through their appeals process and calling customer service representatives until someone decides to let you have surgery (this will take longer but has higher chances of success). If neither appeals work out, then unfortunately there is no guarantee that they’ll cover it—but don’t give up hope!

What Happens If I Sue For A Denied Tummy Tuck?

If you’re like me, you probably don’t have a lot of money to spend on legal help. But it’s possible that your insurance company will deny your claim for a tummy tuck, and there are some things that you can do about it.

If the insurance company refuses to pay for your surgery, they may be able to be sued by YOU! You may be able to recover:

• The costs of your surgery if they don’t pay it back
• Damages for pain and suffering if they don’t want to pay.

what insurance covers panniculectomy

Nose job

If you were to ask certain celebrities, they may admit to a nose job—but would say theirs were medically necessary. The truth is a bit more complicated. Rhinoplasty (a “nose job”) can be performed to correct impaired breathing caused by structural defects of the nose (such as a deviated septum, one source of chronic congestion), but it also—and often—includes aesthetic tweaks to enhance facial harmony and the proportions of the nose. Insurance covers the portion of the surgery that’s medically necessary. However, “once we’ve finished the structural work, we mark the time on the operative record,” and after that, it’s on the patient’s tab, says Deborah J. Johnson, MD, a plastic surgeon in Sacramento, CA and past president of the American Society of Plastic Surgeons (ASPS). Surgery or no surgery, these 13 health insurance tricks can save you thousands.

Otoplasty (Ear surgery)

Ear surgery, also known as otoplasty, can improve the shape, position, or proportion of the ear, according to the Mayo Clinic. It can also correct a defect from a birth defect or injury, they say. Both adults and children can benefit from otoplasty, but if you make it to adulthood without it, then any changes you might want to make “will probably be on your dime,” Dr. Johnson says. Otoplasty in adults is covered by insurance, however, when it interferes with hearing. When it isn’t covered, the average cost of otoplasty was $2,909, per 2017 statistics from the ASPS. This type of surgery isn’t as popular as the most in-demand cosmetic treatments around the country.

Eyelid Lift

When eyelids appear droopy, you might look permanently tired—but this sagging can also impair vision, according to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Surgery, called blepharoplasty (eyelid lift) can correct these problems. Without insurance, the average cost is $3,026, according to the ASPS. Dr. Johnson says it actually will in two situations. The first is when extra skin weighs down the eyelid, obstructing the patient’s vision. The second is when the muscles of the upper lid become stretched out over time, leaving the patient with a sleep-eyed look that also impairs vision. This is how dermatologists and plastic surgeons look younger without an eyelid lift.

“Beauty” marks

It’s called a beauty mark, but you don’t think it’s so beautiful. If you decide to have that mole removed, will insurance cover it? According to Dr. Johnson, “even if the mole turns out to be benign, insurance will usually cover its removal if it strikes a doctor as suspicious.” Suspicious moles may include those that follow the ABCDEs the Skin Cancer Foundation lists: those that are asymmetrical, have uneven borders, are not uniform in color, moles with a diameter larger than a pencil eraser and moles that are changing, bleeding, or itching. If it does turn out to be cancerous, Dr. Johnson adds, “your insurance plan should also cover surgery to reconstruct your appearance.” Some people might confuse moles or lesions for beauty marks which is why you should check your body for these 7 skin cancer symptoms now.

Boob jobs

Breast augmentation—aka a boob job—may be covered by insurance in certain circumstances. Dr. Johnson explains that when you talk about plastic surgery covered by insurance, the question always comes down to what is “cosmetic” versus “reconstructive.” “It’s cosmetic if it’s simply the altering of the normal to make it look better but still normal. Aging is normal, so if someone comes in for work on their breasts due to the normal aging process, we consider that cosmetic,” Dr. Johnson explains. “If it’s addressing functional disabilities and deformities, it’s reconstructive.” But the notion of what is “normal” and what is a “deformity” is constantly evolving, as Johnson points out.

Since 1998, insurance companies have been required by law to cover not only breast reconstruction following mastectomy but also reconstruction of the other breast to make breasts look symmetrical and balanced after mastectomy and any physical complications at all stages of mastectomy.

This includes revising previous reconstructions, points out Maria LoTempio, MD, a New York City-based plastic surgeon specializing in reconstructive and cosmetic surgery exclusively for women. That means that following an initial reconstruction, a woman can opt for a different reconstructive approach for the purpose of enhancing the aesthetic result. Dr. LoTempio notes that the likelihood of insurance covers diminishes as time passes following the initial reconstruction, although in one case, a patient received full coverage for significant revision nearly eight years following her initial surgery. Dr. Johnson suggests that patients read their plans carefully and work closely with customer service representatives at the insurance company to determine whether the desired surgery will be covered.

Apart from breast reconstruction, breast implant revision surgery may also be covered by insurance, says the ASPS. Dr. Johnson points out that women who have already undergone a “boob job” may be able to have the removal of their implants paid for by insurance if the implants are found by a doctor to be faulty. Here’s everything you always wanted to know about breast implants.

Breast reduction

On the flipside is breast reduction surgery, a procedure where the surgeon removes fatty tissue, glandular tissue, and excess skin, says the ASPS. Beyond aesthetics, women may choose breast reduction to address physical discomfort. The ASPS says that many insurance companies cover this surgery. One downside, says Dr. Johnson, is that insurance companies tend to use cup size as a guideline (often denying coverage if you’re not a “DD or larger,” she says).

Dr. Johnson recommends documenting the symptoms and their duration. She also recommends documenting all non-surgical measures taken by the woman that have failed (such as diet, exercise, supportive bras, chiropractic, and massage). It’s also a good idea to document the woman’s willingness to endure scarring in the interest of relieving her symptoms, Dr. Johnson adds, because this shows that her desire for the surgery isn’t frivolous. (If you’re considering breast reduction surgery, here are 8 things you should know before going under the knife for breast reduction surgery, including costs, risks, and benefits.)

Male breast reduction

The American Board of Cosmetic Surgery estimates that up to 50 percent of men in the United States will experience enlarged breasts during their lifetime. For some men, the answer is gynecomastia surgery, which removes excess fat and glandular tissue for a flatter, firmer, and more masculine chest contour.

According to Dr. Johnson, insurance companies are more willing to pay for the surgery in teens and young adults than they are for older adults. There’s a common belief, she notes, that “if this guy made it through his teens and early twenties without the surgery, he’s fine,” she says. Plastic surgery before and after photos might be alluring, but before considering going under the knife read these 13 things plastic surgeons won’t tell you.

Panniculectomy

Following major weight loss, some people may be left with excess skin. Patients may choose to undergo panniculectomy, a surgical procedure to remove excess skin and fat that hangs from the belly. In terms of insurance coverage, the law is still evolving in this area, according to Dr. Johnson. “There was a time a few years back when insurers covered panniculectomy. Then they decided it was a problem of one’s own making and began to deny coverage,” she recalls. “Then the American Medical Association classified obesity as a disease, and states began requiring insurance companies to once again cover the surgery,” Dr. Johnson adds. If you’ve never heard of a panniculectomy, chances are that these unusual cosmetic surgeries will be news to you as well.

Tummy tuck

Whereas a panniculectomy removes only excess skin, a tummy tuck (also known as abdominoplasty) involves the removal of excess skin and fat from the abdomen and a tightening of the fascia that lies on the abdominal muscles, Mayo Clinic explains. A tummy tuck will be covered by insurance, however, when it is done as part of a breast reconstruction. For example, in what is known as a DIEP Flap procedure, Dr. LoTempio uses skin and fatty tissue from the abdomen to replace the skin and tissue removed from the breast during mastectomy, resulting in a soft, natural, reconstructed breast. In SIEA Flap surgery, the blood vessels in the lower abdomen, just beneath the skin, are used. Surgery isn’t necessary if you try these 23 ways to flatten your belly without surgery.

Butt lifts

The average surgeon charges $4,884 for butt implants, so wouldn’t it be nice if insurance would cover it? Spoiler: it won’t. However, if you must undergo a mastectomy for medical reasons, there are surgeons who are able to create new breasts out of skin, fat, and blood vessels removed from the gluteal area, says Dr. LoTempio. This surgery results in a newly contoured and lifted backside and is now routinely covered by insurance, she says. In fact, there are several other flap surgeries that can be performed using thigh tissue which result in a what Dr. LoTempio calls a “mini thigh lift.” Perhaps you don’t need a butt lift and the right underwear to flatter your butt shape will do.

Bunions

You love those high-heeled shoes, but your feet don’t. Now you have a bunion—a painful bony bump on the joint at the inside of your toe. This is a foot deformity. According to Josef J. Geldwort, MD, DPM, a sports medicine doctor and podiatrist in New York City, “more health insurance companies will cover a bunion procedure than you may think. It all depends on the circumstances,” he says. Namely, if your bunion is causing pain and impacting your functioning. While you’re waiting for surgery, try these ways to deal with your bunion pain.

Varicose veins

“I’ve had many patients tell me that they were reluctant to see a doctor for their varicose veins because they thought varicose veins were a cosmetic problem, so their health insurance plan wouldn’t pay for treatment,” says Steven D. Cox, MD, a surgeon at Fairfield Medical Center in Lancaster, OH. It is true that most health plans will authorize treatment of varicose veins if we can demonstrate medical necessity. “If you have large, bulging veins on your legs or thighs, you probably have a problem called venous insufficiency, which meets the criteria for medical necessity for insurance plans,” he says. According to Dr. Johnson, the rule is that “generally, if your varicose veins present with painful symptoms and you’ve tried and failed with non-invasive therapies such as support stockings and sclerotherapy, then insurance will cover the surgery.” It probably won’t alleviate the need for surgery, but here’s why horse chestnuts may provide some relief for the discomfort of varicose veins.

how to get insurance to pay for skin removal on arms

I see a lot of folks, both men and women, who have had gastric bypass or a lap band and experienced what we call ‘massive weight loss’. Typically this is a weight loss of over 100 pounds. Universally, if you are in this group of patients, you will have loose skin on your neck, upper arms, breasts, flanks, back, tummy and thighs and this picture probably looks pretty familiar . The loose skin can be a problem not only due to rashes and skin care issues, but because a lot of patients tell me they still feel heavy with all of the loose skin still there. Commonly performed treatments are skin reduction of the arms (brachioplasty), breasts (lifts and reductions), tummy tucks, and thigh lifts. In today’s times, these procedures are almost always considered “cosmetic”. This translates into no insurance coverage. Over the last 18 to 24 months, at least in my office, we have seen almost a 100% denial rate when we seek insurance pre-approval. If you are considering one of these procedures, my advice is to go into the process assuming you will have to cover the cost yourself. Now, that being said, the costs usually aren’t as high as most folks assume. I have people tell me all the time that they assumed the costs would be in the $20,000 to $30,000 range. The reality is that it is no where near that much. For instance, an arm procedure is about $5,000 total cost. A tummy, about $6,600 and financing options are available. Why no coverage? Well, loose skin removal is simply not considered “medically necessary” by third party payors. Period.

does ppo insurance cover tummy tuck

Bodywork and beauty therapy allows us to look and feel our best, but these procedures can often be pricey. Tummy tucks are invasive procedures that are used to improve the look of the abdomen, and if you’re trying to get one, you may be wondering how to get a tummy tuck paid for by insurance.

Over the course of this guide, we’ll cover everything you need to know about how to get a tummy tuck covered by insurance, including the circumstances in which one would be covered. If you’re wondering, “Will Medicaid pay for a tummy tuck?”, we’ll also go into the circumstances in which you can expect it to.

Does Insurance Cover Tummy Tuck?

Tummy tucks are typically considered cosmetic and elective surgeries because they are rarely seen as medically necessary procedures that will either save your life or improve your quality of life. In the vast majority of cases, cosmetic and elective procedures are excluded from health insurance policies.

Will insurance cover a tummy tuck? Probably not. Now, you may be wondering about cosmetic insurance plans, which sound like they might end up paying out for a tummy tuck. However, cosmetic insurance policies are designed to pay for medical expenses that arise after a cosmetic surgery.

For example, if you go in for a tummy tuck and you end up with an infection that needs to be treated ASAP, your cosmetic insurance policy will come into effect and pay out for you. These policies can also pay out if you have problems in the middle of your cosmetic surgery and the doctor needs to do additional work that you’ll be charged for.

In some rare cases, you may find a policy that will pay out for a cosmetic procedure once in a blue moon, but you can bet that these policies will be far more expensive than your typical health insurance policy. The simple fact is that health insurance was not designed to pay for cosmetic procedures like tummy tucks.

Does Medicaid Cover Tummy Tucks?

Even though private insurance typically doesn’t cover tummy tucks, you may be wondering, “Does Medicaid pay for tummy tuck?” Unfortunately, in the vast majority of cases, you can’t expect Medicaid to pay for cosmetic procedures because that’s not what it was made for.

Medicaid was designed to deal with situations that are medically necessary for the patient. For example, if you need to remove a malignant tumor or if you need to get surgery to manage a hernia. Since tummy tucks are typically only cosmetic, they typically won’t be handled by Medicaid.

That being said, it doesn’t mean that it’s impossible to get an abdominoplasty covered by insurance, even if it’s Medicaid. These operations tend to fall into a grey area, so you’ll only ever know if your operation will be covered if you get in touch with your insurers and explain the situation to them.

Of course, it’ll take a little more work than just asking the carrier “Does insurance pay for tummy tuck procedures?” You’ll have to explain why a tummy tuck is a necessary procedure for you and how it will improve your quality of life and potentially even your overall health.

Compare Medicare Plans Online

How to Get Medicaid to Cover Tummy Tucks

If you’re wondering how to get a tummy tuck covered by insurance, there are a few rare cases in which Medicaid will pay out. In the vast majority of these cases, there are either extenuating circumstances or the doctors will perform a procedure that’s similar but not identical to a tummy tuck.

If you’re wondering how to get insurance to cover a tummy tuck, you’ll need to prove that you need a medically necessary tummy tuck. Unfortunately, explaining to your insurer that boosted self-esteem will improve your overall health typically won’t fly as an excuse when you’re wondering, “Are tummy tucks covered by insurance?”

One situation in which Medicaid will pay out for your tummy tuck is if the excess skin is causing you back pain because of the additional weight it’s putting on your spine. You may also have incontinence that can be solved by a tummy tuck, but those are essentially the only cases in which a tummy tuck will be performed on its own and covered by your Medicaid.

Can a tummy tuck be covered by insurance in other circumstances? There are times when a doctor may perform a tummy tuck at the same time as another procedure. For example, if you go in for a hernia repair and the doctor performs a tummy tuck at the same time, it may be covered by your Medicaid.

Rank and Review Insurance Companies

Help others make better decisions

How Much Will a Tummy Tuck Cost Me?

Will insurance pay for a tummy tuck? Most likely not, but that doesn’t necessarily mean that it’s the end of the world. Thankfully, tummy tucks are relatively affordable as far as cosmetic procedures go, and while you don’t want to cheap out when it comes to your health, you won’t have to if you’re willing to save a bit of money.

The average cost of a tummy tuck tends to be between $5000 and $6000, though this can vary dramatically based on where you’re getting the procedure done and the surgeon’s training. For example, some tummy tucks can cost you as much as $12,000 and some can cost as low as $3000.

If this seems a bit steep to you, it’s always possible to arrange a payment plan with the cosmetic clinic that you intend to work with. This will allow you to enjoy a better quality of life after your tummy tuck without having to worry about being on the hook for a huge sum all at once.

As with most medical procedures, you’ll want to take the time to sit down with your doctor and address what you want out of your tummy tuck. If you need a smaller tummy tuck that’s a little less invasive, you may find yourself paying quite a bit less than the average.