Insurance paying for tummy tuck?

[Luu2008 2]

I was under the impression that a Tummy Tuck is never covered by insurance, I put the story below of how the topic came up, it was very random. Anyway has anyone had experience with their insurance paying for a tummy tuck? Would love to know.

This is a LONG story, maybe TMI but oh well. I was getting a fill this week and mentioned to the nurse that my lower back was in pain (they always ask me, "are you in pain.")had my newborn baby with me (we are adopting him and he is gorgeous!) and the nurse went out to get the Plastic Surgeon consult/nurse practitioner because he'd also adopted an African American infant. We were chatting about adoption related stuff when in walked my fill Dr. He left the room immediatly as if he'd interupted. Then when the fill Dr came back in I he assumed I was having a plastics consult. I explained what it was but that eventually I did want the tummy tuck. He looked at my chart and said we need to start working on your insurance now so that they will cover part of this. I had NO idea that was a possibility.... I do have a panus, have had it since my first daughter an an ER surgery. I lost all my weight after her birth so I know it won't go away. I also get EXTREMELY mild rashes occasionally. I doubt that would be a big enough deal to warrent a tummy tuck.

[Sue Magoo 71]

Luu2008:

I had my panniculectomy covered by insurance (Blue Cross Blue Shield HMO Blue New England). I actually got a Tummy Tuck because a panniculectomy doesn't really give such a great result for someone like me. I'm not sure exactly what my insurance company paid, but my out of pocket cost was almost $7,000. It may have been as much as $20,000 in total cost.

I had rashes that were under the flap that one of my LapBand doctor's and the Plastic Surgeon had pictures of. The Plastic Surgeon submitted paperwork that included a letter from the LapBand doctor. It took about 3 weeks, but it got approved! I never could have paid full price.

Best wishes to you with getting coverage. Back pain along with the mild rash might be just enough.

Good luck.

Sue

Edited June 14, 2009 by Sue Magoo
wasn't clear enough

[Southern Missy 1]

Don't count yourself out -- I think you'll be very surprised.

Something I have always heard everyone say is that you have to be a year out from your weight loss and maintain during that time for them to cover it and here I am, still 35 pounds away from goal weight, and I have already received preapproval to have the panniculectomy (they don't cover tummy tucks, per se, but will cover removal of the pannus).

If this is something you want to have done, then definitely let your physician handle that end of it -- seems like he's doing a great job of getting the ball rolling! :sad:

[Luu2008 2]

I was told I have to go through my primary care Dr for documentation of my back, Lapband Doc will document also but he said the other would hold more weight. With the rash I easily take care of it by drying it with a blow dryer on cool after showering and using powder when its hot and humid out, its really not a biggie just more annoying then anything.

WOW $20,000!? I was quoted 7000 for a Tummy Tuck w/ Lipo by a reputable plastic surgeon a few years ago when I thought I would have it done and then loose weight-due to the panus being so hard to exercise with-then I discovered Spanx and decided to wait (thank you girdle Gods!) Do you think they upped the price because they knew your insurance would fit most of the bill or was it a more involved surgery for you?

[GREATFUL 24]

Insurance is a funny thing. I looked into my insurance paying for at least the panniculectomy portion of my TT. (Will be getting on July 16th, YEA ME). I had pre approval from my insurance, along with their requirements that it be outpatient and in a hosptial and PS that was in my insurance network. So I visit with a three PS that are network. I select the one I want and we proceed to start the process. He does his work in a surgery center that is in the same building as his office, and just a few blocks from the hospital. In order for my insurance to pay for just the panniculectomy portion of the surgery I would have it done at the hospital. We ran the numbers and it was actualy cheaper for me to NOT use my insurance and just pay him cash. Due to hospital charges for the pre surgery room, surgery room and recovery room. So you never know.

Laura

[Sue Magoo 71]

I was told I have to go through my primary care Dr for documentation of my back, Lapband Doc will document also but he said the other would hold more weight. With the rash I easily take care of it by drying it with a blow dryer on cool after showering and using powder when its hot and humid out, its really not a biggie just more annoying then anything.

WOW $20,000!? I was quoted 7000 for a Tummy Tuck w/ Lipo by a reputable plastic surgeon a few years ago when I thought I would have it done and then loose weight-due to the panus being so hard to exercise with-then I discovered Spanx and decided to wait (thank you girdle Gods!) Do you think they upped the price because they knew your insurance would fit most of the bill or was it a more involved surgery for you?

Hi:

I don't think it was more involved. I had a panniculectomy, tummy tuck, and liposuction. It could be the Boston area hospital and surgical costs are higher than alot of places.

I stayed in the hospital for approx. 30 hours. My surgeon practices in a Wellesley, so that may be the reason too as iWellesley is kind of "hoity toity".

I love my band and my new flat tummy!

Sue

[LiveLoveLaugh 0]

I want you to know I was told by the health professionals to make sure at every appointment mention that you have a rash (yeast/heat) under the skin fold. Make sure both your Lap-band surgeon and GP notes it in your chart every single appointment. Even if it's not flared up or if it's even there this will give you a history of skin problems and infection. When the Doctor writes you a script for a cream fill it a few time also. Your insurance cannot surpass the medical history and when or if you have to battle coverage you have the upper hand and have documented history "You will win in the end".......

Edited June 19, 2009 by LiveLoveLaugh

[Luu2008 2]

thanks for the advice, developing that stupid rash at the moment due to warm weather but again I can easily treat this on my own. Part of me wants to get rid of it like I usually do the other part wants to go to the Doc and document it. To be honest I have NEVER shared this with a Dr due to the humiliation of feeling like I'm not having proper hygiene.

[LiveLoveLaugh 0]

I know what you're feeling and never be mistaken this condition is not from bad bathing etc.. It's a type of infection that's due from lack of air flow and irritation from trapped moisture. If this goes untreated by a cream & sometimes oral perscription by your doctor this can stay in the blood stream only to pop up sooner than later. Some over the counter items only mask the real problem and it comes back time and again only with more fire and pain.

So please don't be ashamed to let your doctor know of this condition it's very inportant to get it treated and better yet documented for your finale good riddens of it forever when you get a Tummy Tuck. Amen!!

Sending you lots of HIGH FIVES....... Cynthia

[goodtimes 0]

Good morning LuLu, Yes maam, insurance will cover that panni. I've just went to my main doctor and she was like u ready, there are codes that they have to put in order to submit to insurance. When I went to a consult, the price is $7,500. But I am hoping that insurance will pay a portion and then I will take out a loan to pay for the rest

[Luu2008 2]

Well my rash is getting worse as the summer progresses so even though I am totally humiliated, I know I shouldn't be but its a mental thing that I can't shake. I've decided I am going to my Dr. I think the worsening of the rash is due to weight loss-more skin-and the fact that I am exercising and more active. Also I am getting rashes in places I haven't before-like under my breasts, and the 2nd upper tummy skin roll, under my breast is manageable, I don't know what is up-very new. My husband is a Vet and in the past I used prescription grade nyastatin (sp?) cream, did the trick every time, so now I'm using it and its doing absolutely NOTHING for tummy but is helping the breast area, argh...tired of the miserable itchy/burning!

[CarmenPonce 0]

I am a health insurance agent and at this point (as far as I know) no insurance carrier is covering cosmetic surgeries post weight loss.

Now panniculectomy (or a panni) is the removal of excess skin which may be medically necessary in some cases, such as in the case of the excess skin causing infections or ulcers. So, in this case the panniculectomy would be covered if you doctor recommends and insurance approves.

An abdominoplasty (or a tummy tuck) is not only the removal of excess skin but also tighten of the abdominal muscles and Lipo sculpture. This procedure is considered purely cosmetic and not covered by insurance.

I hope this answers some of you questions.

[SkinnyKathy 99]

I was banded last September at a starting weight of 433. So far I have lost 65 pounds and am continuing to lose. All of my health issues are getting better as I lose weight except the pannus area and rashes - this is getting worse. I have had a pannus since my teenage years, and it got noticably worse with each of my two pregnancies. Now as I lose weight it is getting still worse and worse and the rashes are getting harder and harder to treat.

Even though I am far from my goal weight, I have already met with a locally recommended plastic surgeon about a panniculectomy. This would be part 1 of plastic surgery for me, with either an extended Tummy Tuck or lower body lift when I get to my goal weight.

The plastic surgeon submitted to my insurance (Anthem Blue Cross PPO) and they denied it. They had a bunch of criteria to pay for a panniculectomy:

1. 18 months since lap band was placed

2. significant weight loss reported

3. BMI lower than 30

4. Photos show skin fold to hang below the pubic bone

5. Reports of 3 months of rash treatment

I already meet 2, 4, and 5. I will meet 1 soon enough. But honestly I may never meet 3. At my height (5' 9.5") a BMI of 30 is around 200 pounds. Given my starting weight of 433, I may never be able to get to 200 pounds. In fact, my doctor's goal for me is to get below 250.

I can deal with the idea of not being able to get the surgery now, although it is getting harder and harder to exercise and rashes are getting worse, but I would really like to get the surgery eventually! But it seems to me that a fixed BMI number is an unrealistic goal for someone who started at a BMI of 63.

I am getting my general practitioner and my chiropractor to write letters of medical necessity (I forgot to mention, back problems are also getting worse) but my PS is not optimistic that the insurance company will change their tune. What do you all think? Any chance of getting them to make an exception given my high starting BMI?

By the way, for stubborn rashes, I HIGHLY recommend Zeasorb powder on top of prescription antifungal cream. It really helps to absorb excess moisture much better than regular powders. You can buy it in most drugstores where they sell footcare products, but sometimes it is behind the pharmacy counter even though it is non-prescription.

Edited July 16, 2009 by FutureSkinnyKathy

[Sue Magoo 71]

Kathy:

Try to get them to make an exception, but if they don't, don't give up. Give it time. When I weighed 324 lbs. I couldn't imagine that I would ever be under 200 pounds, but one year after I started my weight loss journey (9 mos. post banding) I hit 199. I'm 5'7". Once you are at your sweet spot you may see that you consistently loose 10 pounds a month. They will add up fast and you could be under 200 before you know it. I am very comfortable at the 175 to 185 level, though my healthy bmi is at a weight of 159. Personally, I never plan to get to the 159. As I loose more weight it comes off of the top and not enough off the bottom so that I look gaunt on my face, and boney in my neck and shoulder area. I don't like people asking if I've been sick, so I choose to stay at the 175 to 185 level for the rest of my life.

I was fortunate with my medical insurance because I got them to pay for the panniculectomy portion of my Tummy Tuck. My band surgeon and the plastic surgeon both wrote letters and submitted pictures of the rash and my overhanging skin. If you look at my profile page you'll see the pics of me the day after my band and before and after my tummy tuck.

Best wishes to you and getting your insurance to help with coverage for your panniculectomy.

I love my band and my new flat tummy!

Sue

[Lori@embarqmail.com 0]

I too had the same issues with the rash, infection, etc. in the folds of my "fat". My aunt used to work in a hospital and told me to go out and buy a bottle of BAN Roll On deodorant (unscented or regular) which currently comes in a lime green bottle and roll that on the infected area (under the fat on my stomach and under my breasts) and wow w/in few days, infection is gone, no more rash. I have been using BAN every day since after I get out of the shower in the morning and I am so happy now.... try it.