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.

Hi:

My doctor told me that a panniculectomy only takes care of from the belly button down. So, if you have any excess skin above the belly button it wouldn't be taken care of. In addition, when they do the full tummy tuck they tighten the abdominal muscles back tight like they should be. If you have a panniculectomy there is no muscle tightening - only cutting and stitching. To me it seemed like way too much pain and recuperation time to not get it done all the way.

Best wishes to you with your future plastic surgery.

I love my band and my new flat tummy!

Sue

Sue, thanks for the info. I know it would be best to have the whole tummy tuck, but just don't know how I will aford it. Right now I really just want the hanging part taken off. For me above the bellly button does not bother me at all. I just don't know what it is going to be like taking the skin off and not fixing the muscel.

Sue, thanks for the info. I know it would be best to have the whole tummy tuck, but just don't know how I will aford it. Right now I really just want the hanging part taken off. For me above the bellly button does not bother me at all. I just don't know what it is going to be like taking the skin off and not fixing the muscel.

Emilie:

Try looking at the website makemeheal.com They probably have some pictures before & after a panniculectomy. I saw some pictures somewhere for that, but I cannot remember where. I wasn't happy with what I saw for me. However, you may be happy with it. You may even try googling panniculectomy images.

Best wishes to you.

I love my band and my new flat tummy!

Sue

Hello everyone, Haven't checked in for a while. Just wanted to say to please document everything...don't be shy to communicate with your primary physcian. I am two years out highest weight 231lbs. down to 165lbs. I have been at this weight for about a year and a half. last May of this year 2009. I had a breast reduction with lift and a tummy tuck. YES my insurance company [Health hmo] covered ALL of it. No out of pocket fees. I DOCUMENTED EVERYTHING rashes blisters etc. I had my doctor document everything in person and arranged to phone in to his nurse anything related to my discomfort and put it in my file. Although you may think as I do that I have not lost as much as I wanted too,My dr. said that everyoe settles sometimes at the weight our bodies are set at. Do not give up...Please research on the web about how to appeal if you get denied. Happily I did not have to but I was ready for rumbling with my insurance co. if I had to. Please be your own advocate,You have not worked this hard only to be half done with your accomplishments! Good luck to you all and fight to be healthy!

Thanks for the update! Im in the very beginning stages of the PS journey. I know that my insurance covers TT's now but its nice to hear an insurance success story.

My only question is how did you get them to pay for a boob lift? If I could finagle that I'd be in heaven!

Hi Chocolate Snaps, Love your name....I actually went in for a follow up for something else. I also told him about my recurring headache, neck and lower back pain. When he tapped my neck and back he said that I was wincing. He gave me a referral to a PS. The surgeon took lots of photos and measurements of my breasts and also of my tummy. I was approved in just 10 days! He and I were shocked that they would cover all. So please document all with photos and also in your case I would call and/or see your primary DR with complaints of your pains and of rashes under your skin...including your breasts...also get prescriptions for anti-fungals. I hope for your success! Linda

Awesome, I have my first PS appointment tomorrow and will definitely mention all of the boob related issues I've had. I have dealt with back and neck pain since I was a teenager and have been being treated with antifungals for my back rolls and under-boob area (technical term :smile:) for almost as long.

The tricky part may be getting my PCP to attest to this because he is usually unsupportive and has resisted giving my referrals to specialists to treat the back and skin problems. But he has to admit to the numerous pain and antifungal scripts he's written and to my recent emergency room visit for a severe pinched nerve in my back. Even though he's a jerk,he isn't tougher than me.

I know thats a huge long story...but its true. I really appreciate your well wishes and response. See ya in the flat and perky lands!

Hi again, Chocolate snaps..in California, we have insurance codes..Look up New York Health and safety codes online to see what you have under the heading of reconstructive surgery. Also check to see what your state insurance codes says about coverage for these surgeries as well. If you have a chance go online and type in cpt and icd codes and their definitions..these are universal codes. Go on the web under WLS and find some examples of letters of denial if you are denied coverage. These may be a guide to help you with examples that pertain to you, for you to write a letter of appeals. Hope this helps! Keep in touch Linda

Thanks you so much Lindy! I had no idea how to find those things out. Im going to start searching asap!

Carmen

I thought yuou might have an answer on this one. I have a large pani but just on my right side, it hangs low and looks real bad on the other hand the left side is protruding a bit but nothing like the right side. I was diagnosed with having Lumbago last August 2009. I have had numerious episodes of lower back pain and at times to where I am not able to walk much less move. I have been in the maintenance phase for over a year now and doing rather well. I do get rashes but manage them on my own. I have blue cross/blue shield a basic plan that I am told is very good more so for weight loss surgeries and other things related to the weightloss surgies. It is a federal employees health plan (government) what is your take on the posibility that I might get approved due to the large un eaven panni and my Lumbago? please contact me at my home e-mail address. sa-schrum@yahoo.com Thanks so much

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.

Insurance may cover removal of excess abdominal skin if it causes infections or rashes that do not repsond to medication over a period of months.

Keep in mind that a simple skin removal (panniculectomy) is a far cry from a nicely done abdominoplasty.

My website has links to many of the INS companies plans a criteria, plus some useful tips for getting coverage:

Plastic Surgery Pateint Resources and Articles - Dr. John Lomonaco

well ive always had kinda hab ging skin and a rash under there so im hoping wheni finally am at goal ill be approved for tt.i have bsbs michigan and ive heard its covered.

oops sry for typing mistakes,bsbs i heard pays if its tt,plus my stomachs always been hanging,i sure hope so pants and everythinbg would fit so much bedtter the rest i can deal with,plz lmk if anyones had bsbs michigan pay theres i live louisanna:confused:

if any of you who have oxford freedom, i thought this link might be of interest. looks like they will cover an abdominoplasty.

https://www.oxhp.com/secure/policy/abdominoplasty_1008.html