How to get Insurance to cover Plastic Surgery

[Tinka504 46]

Hello Ladies and Gents,

Quick question, so having dropped over 200#'s I have now I have that lovely saggy skin issue, I can handle most of it, but the thigh's are killing me. It's causing issues (friction, and swinging in a most fugly fashion) and my insurance did not even cover the surgery, that was out of pocket. So, anyone have any idea on how to get insurance to cover it when I think its medically needed?

Thanks a bunch!

[smokenhaze 9]

First of all, congratulations on the weight loss!!! When I first met the bariatric doctor she advised and took note on all problems with my skin, chaffing, burning, infections....if anything problematic happened after the surgery it would be documented so I can get a higher chance of being cover for plastic surgery.

I would suggest going to the medical doctor and see if she/he could write a letter of recommendation to submit to the insurance to get it covered. Be sure to state to the doctor all the problems you are having with your skin, it could possibly lead to infection, which is why it would be medically necessary.

[KDM74 186]

If you call your insurance company, they can tell you if your plan even covers the surgeries at all, and what it will take to MAYBE get them covered. My insurance does cover all skin removal surgeries, however I have to supply documentation of debilitating infection or skin irritation from my PCP for 3-6 months (depending on the area) with photographs, and for my stomach, it also has to have caused a cellulitis infection that required antibiotics. And they won't even consider it until I am at least 6 months out from a stable weight. My bypass is on Monday so I am planning ahead.

I am a medical coder, so here are the CPT codes for the most common procedures so you can ask specifically what is covered:

15830 - panniculectomy (this is NOT a Tummy Tuck, insurance will not cover TT because it is cosmetic. This is only for skin removal, not muscle tightening or changing belly button location)

15832 - thigh lift (inner thigh)

15833 - leg lift (lower leg)

15834 - hip lift (outer thigh/hip)

15835 - buttock lift

15836 - arm lift (upper arm)

All of the "lifts" are actually termed "removal of excess skin" in the particular area. For a full lower body lift, your surgeon may combine several of the above procedures for billing. Your insurance may only cover the panniculectomy and not the butt lift, etc. For your purposes you would want to ask about 15832. They should also be able to tell you what the average price in your area is if they do not cover it. Good luck!

[Annek2014 58]

Great information!

[MichelleTN 169]

Good info to know!

[Cupcake 801]

Hello everyone I just had a Tummy Tuck with muscle repair, and belly button removal and Lipo and insurance covered the entire process, you have to check with your insurance company and everyone insurance is different, I have federal insurance which covers just about anything, but you must have documentations from day one and as stated above some insurance ill cover the skin removal only to relieve any hanging, skin, liquid fluids, and rashes etc it also has to hang a certain amount below the mons, you have to be a year post opt of surgury as well as your weight have to be stable for 6 months and documented, showing the different techniques, creams, and exercise you have done to address the issue . Good luck I am now 5 days post opt from my tummy tuck and doing great.

[Cupcake 801]

Hello everyone I hope everyone is doing great keep up the great work as well as remember to get in your Protein, drink your Water, and exercise, for those looking into getting insurance to pay for any reconstructive surgery endure that your doctor document everything including all recommendations on how to treat your problem remember to always add in you have back pain from the excessive skin your covering on your stomach . Good luck .

[cavery77 39]

PT 15830 Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy.

This is what my insurance Aetna sent me. Can someone tell me what this means in non medical terms

Sent from my iPhone using the BariatricPal App

[KristenLe 5,980]

It appears to be skin removal in the abdomen but from comment above it is not a full Tummy Tuck (which includes muscle tightening and moving the belly button).

[cavery77 39]

It's above my belly button I have more skin. I just want my stomach skin gone. Will working out tighten the muscles?

Sent from my iPhone using the BariatricPal App

[KristenLe 5,980]

I don't think enough to make a difference. See what a plastic surgeon says - this surgery may include the area you need without involving muscles.