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Is an Abdominoplasty Covered by Insurance?

Published by Dr. Brandon Richland, MD

Most of the insurance companies do not provide coverage for abdominoplasty. Most of the time, the total cost of the procedure must come out of the patient’s pocket. However, a medically necessary tummy tuck, meaning the procedure is essential to improve a person’s health, some reimbursements may be received depending on the insurer and the individual’s plan.

Medicaid and Medicare are two insurance companies that may have insurance coverage for tummy tucks or some costs of the surgery, if the need for the medical procedure is purely for medical reasons only.

Key Takeaways of Abdominoplasty Covered By Insurance

  • Insurance companies do not cover abdominoplasty as it is considered an elective procedure.
  • Requirements for insurance coverage may include physical symptoms that cause functional limitations, preauthorization from the insurer, and evidence of medical necessity.
  • Medicare and Medicaid usually do not cover elective surgeries such as an abdominoplasty, but there may be exceptions if deemed medically necessary, with supporting documentation and evidence provided to the insurer.

Differentiating Between a Tummy Tuck and a Panniculectomy

Tummy tucks reshape the tummy by eliminating visible signs of aging or extreme weight loss, while providing structural support through tightening of the abdominal muscles for improved posture and core strength. Most insurance companies will not cover a tummy tuck procedure, unless found medically necessary due to symptoms such as functional limitation. In that case, it may be covered depending on eligibility criteria specific to each health insurance provider.

Panniculectomy is a medically necessary surgery as it reduces dangerous significant accumulations of excessive tissue in overweight or obese people, and those suffering from related medical conditions such as lymphedema or urinary incontinence. A panniculectomy can be covered by insurance as long as patients provide the necessary documents.

Determining Medical Necessity for Insurance Coverage

Insurance companies use specific criteria and guidelines in determining medical necessity for cosmetic procedures such as an abdominoplasty.

A primary criteria of most insurance companies that determine insurance coverage eligibility for tummy tucks is proving that other treatments that address excessive fat on the abdomen have already been attempted and were found ineffective.

Other requirements for coverage are common symptoms that must be proven for legibility; chronic abdominal pain in the belly button, functional limitations caused by excess skin or hanging skin, and lower limb edema from infection due to deep skin folds.

Medicaid and Medicare coverage options

Medicaid and Medicare are two reputable insurance providers that are known to cover cosmetic surgeries if found necessary to improve a patient’s health.

When patients want to determine if their desired abdomen procedure qualifies for insurance coverage, they must carefully differentiate between a regular tummy tuck and panniculectomy procedure.

Panniculectomy is recommended when there is severe skin laxity caused by obesity or pregnancy-related issues. In contrast, classic abdominoplasty aims at tightening and smoothing the abdominal area primarily for aesthetic purposes.

Challenges in Getting Abdominoplasty Covered by Insurance

Most health insurance companies define elective procedures as those that can be delayed without risk or harm concerning physical health.

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The Classification of Abdominoplasty as an Elective Procedure

Insurance companies do not cover abdominoplasty because it is considered a cosmetic procedure instead of medically necessary.

Criteria for medical necessity include evidence that physical symptoms impair daily function and alternative nonsurgical treatments have failed. These make it difficult for individuals seeking abdominoplasty coverage, leaving them solely responsible for costs and potentially high out of pocket expenses associated with the surgery.

Insurance Policies and Exclusions for Cosmetic Surgeries

Some cosmetic procedures not related to abdominal contouring may be regarded as medically necessary in some instances. These potential treatments can include panniculectomy, like mentioned before this is a surgery specifically to remove excess skin and fat from the lower abdomen.

There must be a medical necessity established and pre authorization required for coverage. Insurance companies usually use criteria such as potential improvement on physical symptoms or functional limitations due to a large abdominal muscle wall fold that causes chronic irritation and interferes with daily activities before approving monetary compensation.

Limited Coverage Options and High Out of Pocket Costs

Patients can expect limited options and high out of pocket expenses. This is because tummy tucks are generally considered elective surgeries by most insurers and are not medically necessary.

Insurance companies rarely cover them, as they usually consider any cosmetic surgery or elective medical procedures excluded from health plans.

Getting some financial help with surgeries such as a panniculectomy may be possible if there’s a medical necessity case behind it.

Alternative Financial Options for Abdominoplasty

There are other possible options for getting abdominoplasty covered by insurance such as; combining it with hernia repair, or accident insurance, and through payment plans and financing options available from outside companies or even possible from the plastic surgeon.

Combining Abdominoplasty with Hernia Repair for Coverage

Combining the procedure with an umbilical hernia repair may benefit patients seeking abdominoplasty coverage from their insurance company. By adding a medical component to plastic surgery, patients can reduce the risks associated with the umbilical hernia and potentially increase their chances of insurance coverage.

For this approach to succeed, patients must meet specific criteria and guidelines set out by individual insurance providers. This combination should only occur after a thorough discussion between the patient and surgeon, considering medical necessity and conditions that might benefit from both procedures simultaneously.

When medically necessary criteria are established with combining abdominoplasty and umbilical hernia repair, it is important for those seeking coverage to document all relevant evidence, including any functional limitations caused by these symptoms or conditions, before they submit pre authorization requests for surgical procedures.

Exploring Payment Plans and Financing Options

Patients considering abdominoplasty may find affordable financing options useful. Plastic surgery centers often set up payment plans and credit cards customized to each patient’s needs, allowing some of the cost of an abdominoplasty procedure to be paid off over time.

Healthcare lenders may also provide competitive terms and flexible financing options to cover tummy tucks. With loans, patients are able to spread out their payments to pay for the total cost in manageable increments over several months or years with reasonable annual interest percentage rates. CareCredit provides financial plans with affordable monthly payments for tummy tuck surgery and other cosmetic and plastic procedures.

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Navigating the Insurance Process

Getting insurance coverage for a tummy tuck can be a complicated process, but that doesn’t mean it’s impossible to claim.

Open communication with insurance companies can be beneficial in providing necessary medical documents and helping secure pre authorization. It helps identify any exclusions or limitations on medical benefits that may affect the outcome of the claim. Seeking assistance from patient advocates or experienced plastic surgeons regarding insurance coverage can greatly benefit patients navigating the insurance process.

Communication between the healthcare provider and insurers may also promote efficiency in obtaining authorizations for medically necessary procedures. With the two entities communicating directly, paperwork delays may be reduced as there is no more third party going back and forth about the needs and requirements.

Frequently Asked Questions About Abdominoplasty Covered by Insurance

1. Is Tummy Tuck Covered by Insurance?

In most cases, insurance does not cover the cost of abdominoplasty procedures. The procedure is considered cosmetic, surgically elective, and not covered by most plans unless it is deemed medically necessary for reconstructive reasons.

2. What is the Total Cost Estimate of an Abdominoplasty If Not Covered By Insurance?

The total tummy tuck surgery cost ranges from $6k to $13k depending on factors such as extent of procedure, surgeon and anesthesia fees, and facility location charges. To cover all out of pocket expenses for this procedure, one must get a comprehensive cost estimate from surgeons and other medical professionals. Budgeting ahead of time can help mitigate any surprises during the process. 

3. Are There Any Alternative Ways to Pay for an Abdominoplasty Procedure If I Don’t Have Insurance?

Many medical facilities offer financing options or payment plans to help make the procedure more affordable, even without insurance coverage. 

4. What Kind of Follow Up Care Costs Will Be Required After Getting a Tummy Tucks?

Medication and doctor fees are some of the costs associated with tummy tucks post-op. After having an abdominoplasty performed, patients will need to visit their doctor regularly throughout recovery for follow up appointments and take medications as prescribed, allowing them to track progress and observe signs and symptoms if something seems off or abnormal so action may be taken swiftly where needed.

5. How Long Does Recovery from Tummy Tuck Surgery Usually Take?

It usually takes several weeks to fully recover from a tummy tuck procedure since this requires significant diet and physical activity changes. At the same time, healing occurs to prevent poor outcomes such as infections or other complications associated with abdominal surgeries. Individuals should expect about 2 to 4 weeks of downtime post op before they can begin any exercise activities again, which could vary depending upon individual circumstances.

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Conclusion and Summary About Is an Abdominoplasty Covered by Insurance?

Insurance companies generally do not cover abdominoplasty as it is considered a purely cosmetic procedure, making out of pocket payment the most likely option for paying the whole tummy tuck cost.

The cost of an abdominoplasty procedure may be expensive for most, but there are many ways for patients to lessen the cost even without insurance coverage. These include opening a health savings account, getting a personal loan or finding a healthcare lender that has reasonable monthly payments. Patients should carefully consider their financial options and thoroughly research insurance providers to determine if any coverage exists for their tummy tuck procedures.

Overall, it’s best to consult with your healthcare provider to see what options you might have to avoid the financial strain of paying in full for your tummy tuck surgery.

Please note that this article is intended for informational purposes only and should not be construed as medical advice. Before making any changes to your treatments, please consult with your healthcare provider to discuss the appropriateness and safety of such changes.

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About the Author

Dr. Brandon Richland, MD is a respected Board Certified Licensed Plastic Surgeon in Orange County / Southern California specializing in cosmetic and reconstructive surgeries.

Driven by his passion for medicine, Dr. Richland obtained his Doctor of Medicine (M.D.) degree from the prestigious program at Saint Louis University (SLU) School of Medicine in 2013. His exceptional skills were recognized when he received the McGraw Hill / Lange Medical Student Academic Achievement Award, and graduated top of his class with Honors. For his undergraduate degree, he attended University of California, Los Angeles (UCLA) and graduated with Honors in 2009.

To further enhance his surgical expertise, Dr. Richland completed his Residency in Plastic Surgery at the University of California, Irvine (UCI) from 2013 to 2019 earning the Academic Achievement Award twice during this period. A total of 14 years in dedicated schooling and medical residency.

Dr. Richland is actively involved with healthcare and medical societies, as a Diplomate of the American Board of Plastic Surgery, a member of the American Society of Plastic Surgeons, American Society of Aesthetic Plastic Surgeons, and the California Society of Plastic Surgeons.

Contact Dr. Richland today by visiting RichlandMD.com, scheduling a cosmetic consultation, or by calling 714-241-0646 or 949-945-0025 directly.