Cosmetic Surgery Tips

When does insurance cover tummy tuck

Tummy tuck surgery is typically covered by insurance when it is used to repair a hernia or as a result of pregnancy. In many cases, insurance will cover a tummy tuck if the procedure is performed in conjunction with another procedure, such as liposuction

A tummy tuck is a procedure that removes excess fat and skin from the abdomen, resulting in a flatter stomach. The procedure is most often performed on people who are obese or who have had children.

While insurance may cover your tummy tuck surgery, it will depend on your specific policy. And if you’re not sure what kind of coverage you have, it’s best to check with your insurer before the procedure.

Tummy tucks are usually considered elective procedures, which means they aren’t medically necessary. However, some insurers will cover them when they’re done as part of a bigger surgery that is necessary for your health. For example, if you’re undergoing an abdominoplasty (a breast lift) at the same time as your tummy tuck, then your insurance might cover both surgeries as part of one larger operation.

If you have an HMO plan through Medicare or Medicaid, you’ll need approval from them before any type of elective surgery can be scheduled. And even if you do get approval from these programs, there may be limits on how much they’ll pay for each individual service—like liposuction or breast augmentation—so be sure to check with them before going under the knife!

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tummy tuck is a common cosmetic procedure to remove excess skin around the midsection. It is a popular option among women who have had children and both men and women who have lost a large amount of weight, either through diet and exercise or weight loss surgery.

After one of these events, you may be left with excess skin around your middle, even if you have gotten rid of the underlying fat, leaving your midsection looking flabby, no matter how much you exercise. Not only that, but you may also become prone to rashes and skin infections in between the folds of excess skin, which can be quite uncomfortable and even painful.

Covering Tummy Tuck Costs

One of the first questions that many of our patients ask is, “Can a tummy tuck be covered by insurance?” The answer to this question is both yes and no. In many cases, a tummy tuck is merely a cosmetic procedure, and most insurance plans will not cover this. However, if you are experiencing rashes or skin infections, it then becomes a medical need to have the surgery. In this case, you may be able to get some of the costs of your tummy tuck covered by insurance.

Why only some of the costs, you ask? A tummy tuck is performed in two stages. The first stage involves tightening the underlying abdominal muscles to create a smooth contour. The second phase involves removing the excess skin so that the remaining skin can be tightened over your middle. For medically necessary procedures, insurance will cover the second phase of the procedure, as removing the excess skin is required to eliminate the risk of rashes and infections.

A Tummy Tuck for Your Budget

After your insurance has covered the skin-tightening portion of the procedure, you’ll still be responsible for paying for the muscle-tightening phase. Here at the Offices of Dr. Michael J. Streitmann, we want you to be able to have the procedures you desire to achieve your dream body. That is why we offer flexible payment plans to help you fit tummy tuck surgery into your budget. We’ll work with you to come up with a payment plan that best meets your needs.

Before we perform any procedure, we’ll provide you with a free consultation to review the details of the tummy tuck procedure, recovery, and ongoing care processes. 

WILL INSURANCE COVER ANY PART OF TUMMY TUCK COSTS?

In general, abdominoplasty procedures are usually elective or cosmetic procedures. Such procedures are likely not eligible for insurance coverage. Patients with epigastric umbilical, ventral, or incisional hernia may be able to receive coverage for this portion of the surgery.

It is vital that a general surgeon be present during the functional part of the operation to repair the hernia. Generally, full disclosure of hernia and the cosmetic part of the procedure will be described through the insurer.

Issues to Contemplate

Enormous panniculectomies, which refers to large abdominoplasties on patients who have received gastric bypass procedure will, at times, be covered by insurance if there are functional issues including back pain, and rashes and dermatitis beneath the large pannus, after massive weight loss.

Plastic surgeon Dr. Paul McCluskey provides tummy tuck surgery to patients in Atlanta, Buckhead, Georgia, and surrounding locations.

What is Panniculectomy

Significant weight loss is a healthy approach for people who are suffering from obesity. However, the excess skin that remains after the weight loss is not healthy. The excess skin may be heavy enough to lead to physical pain.

It can impact mobility, restrict physical activity, and affect personal hygiene. Skin folds may become tender and prone to yeast infections. Panniculectomy is a surgery to eliminate the excess skin that remains after major weight loss.

The patient may be able to receive insurance coverage for this procedure as it is considered reconstructive when it is undertaken to correct or relieve physical symptoms. But the law is still evolving around this issue.

A few years ago, insurance companies offered coverage for a panniculectomy. Subsequently, they decided that it was an issue of one’s own making and started denying coverage for this surgery.

After the American Medical Association classified obesity as a disease, states started requiring insurers to offer coverage for the procedure once again.

Other Specific Cases where Tummy Tuck may be covered by Insurance

Panniculectomy is a procedure that eliminates only excess skin. On the other hand, a tummy tuck (abdominoplasty) involves the removal of excess skin and fat from the abdomen area as well as a tightening of the underlying abdominal muscles.

A woman may feel like they need a tummy tuck following pregnancy, especially if their expanding belly causes the abdominal muscles to separate vertically, in a condition called diastasis. But insurance does not offer coverage for diastasis repair, which is considered by the medical profession as strictly cosmetic.

An abdominoplasty may be eligible for insurance coverage, but when it is undertaken as a part of breast reconstruction.

For instance, in what is called a DIEP Flap procedure, the surgeon will use fatty tissue and skin from the abdomen to replace the tissue and skin removed from the breast during mastectomy, which results in a natural, soft, reconstructed breast.

The blood vessels in the lower abdomen, right underneath the skin, are used in SIEA Flap surgery. Regardless of the approach, the contour of the abdomen can be improved and smoothed through a cosmetic abdominoplasty.

Patients should ideally discuss with their insurer beforehand in case of an abdominoplasty. The surgeon’s staff may be able to offer the patient information and assistance on the insurance documentation and formalities.

Financing

Patients who do not receive insurance coverage for a tummy tuck procedure may be able to pay for their surgical procedure using major credit cards.

They can also use various financing options to pay for their abdominoplasty, including financing from medical care financing firms providing loans exclusively for medical purposes.

These companies usually provide more competitive interest rates, faster loan approvals, and easy monthly installments of up to 60 months. Cosmetic surgeon Dr. Paul McCluskey receives patients from Atlanta, Buckhead, Georgia, and nearby areas for a tummy tuck.

How To Get Insurance To Pay For A Tummy Tuck

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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