How to get a tummy tuck covered by insurance

Panniculectomies and tummy tucks are used to get rid of excess skin around the lower stomach after losing weight.
While a panniculectomy is considered a medical necessity after a significant amount of weight loss, a tummy tuck is an elective procedure for cosmetic reasons.

Common side effects for both procedures include pain and numbness. Scarring is also likely, though it will fade over the course of several months.
Rare complications include infection, significant pain and numbness, and bleeding.

Both types of procedures are invasive surgeries that require a great deal of preparation and post-operative care.
It’s important to find a board-certified surgeon with extensive experience in each procedure.

A panniculectomy is more expensive than a tummy tuck, but it’s often covered by medical insurance. The cost can range from $8,000 to $15,000, plus anesthesia and other extras.
A tummy tuck is less expensive but is not covered by insurance. This elective procedure costs on average around $6,200.

Panniculectomies and tummy tucks share similar success rates. The key is to make sure you lose weight before surgery, as weight maintenance is crucial to maintaining your treatment.

Table of Contents Show

Panniculectomy
Panniculectomy timeline
Tummy tuck timeline
Results of a panniculectomy
Results of a tummy tuck
Panniculectomy candidates
Tummy tuck candidates
Costs of a panniculectomy
Costs of a tummy tuck
Side effects of a panniculectomy
Side effects of a tummy tuck

Panniculectomy and tummy tuck (abdominoplasty) are two surgical treatments aimed at removing excess lower belly skin. They may both be performed in cases of extreme weight loss from natural or surgical causes.

The goal of panniculectomy is to primarily remove hanging skin, while a tummy tuck also provides contouring effects to enhance your muscles and waistline. It’s also possible to have both procedures done at the same time.

The goal for both procedures is similar: to remove excess skin from the stomach. However, it’s important to learn the key differences between the two so that you get the results you want.

Both panniculectomies and tummy tucks target lower belly skin. The goal of the procedures is to get rid of loose, hanging skin that often forms after losing a lot of weight. This may be due to surgeries such as a gastric bypass, natural weight loss, or even pregnancy.

Panniculectomy

A panniculectomy is an invasive surgical treatment. It’s most helpful for people who have recently had weight loss surgery and are left with large amounts of hanging skin on the lower belly.

This type of surgery may be considered a medical necessity if the remaining skin affects your quality of life. For example, you may develop rashes, infections, and ulcers underneath the area of hanging skin.

During a panniculectomy, your surgeon will make two cuts into the abdominal wall to remove excess skin in the middle. Then the bottom portion of skin is reattached to the top via suturing.

Tummy tuck

A tummy tuck is also intended to remove excess skin. The key difference is that this invasive surgery is usually elected for aesthetic reasons and isn’t medically necessary like a panniculectomy.

In some cases, a tummy tuck can help alleviate incontinence and back pain.

With a tummy tuck, your doctor will cut out excess skin while also tightening abdominal muscles. While the surgery itself won’t give you six-pack abs, it will make it easier for you to build abdominal muscles on your own through exercise in the future.

Surgeries of this nature take time. Aside from the actual time spent in surgery, you should expect to arrive at the hospital early for pre-operative care. You’ll also need to stay in post-operative care while your doctor monitors your initial recovery.

Panniculectomy timeline

It takes about two to five hours for a surgeon to perform a panniculectomy. The exact timeline depends on the length of incisions made, as well as the amount of excess skin that’s being removed.

Tummy tuck timeline

A tummy tuck may take two to four hours to complete. Though the skin cutting may be less extensive than with a panniculectomy, your surgeon will still need to shape the abdominal wall in a tummy tuck.

Both panniculectomy and tummy tuck share similar success rates. The key is to maintain a healthy lifestyle following the procedure so you get the best results.

Results of a panniculectomy

The recovery process may be slow, but the results from a panniculectomy following massive weight loss are considered permanent. If you maintain your weight, you shouldn’t need any follow-up surgeries.

Results of a tummy tuck

The results of a tummy tuck are also considered permanent if you maintain a healthy weight. To increase your chances for long-term results, your doctor may recommend you lose or maintain a stable weight before the procedure.

You may be a better fit for one procedure over another. Both panniculectomies and tummy tucks are intended for adults and for women who aren’t pregnant, as well as for those who don’t smoke and are at a stable body weight.

It’s important to remember that while both surgeries target excess lower belly skin, these aren’t weight loss procedures.

Panniculectomy candidates

You may be a candidate for a panniculectomy if you:

have recently lost a large amount of weight and have loose belly skin that you want to remove
are experiencing hygiene issues from excess skin hanging below the pubic region
keep getting ulcers, infections, and other related issues under the hanging skin
have recently had gastric bypass or bariatric weight loss surgeries

Tummy tuck candidates

A tummy tuck may be a good fit if you:

are trying to get rid of “belly pooch” from a recent pregnancy
have trouble getting rid of excess skin around the abdomen despite diet and exercise
are in overall good health and are at a healthy weight
have talked to your surgeon and they want to perform this operation after a panniculectomy

The cost of panniculectomies and tummy tucks can vary drastically, especially when considering insurance coverage. Below are total estimated costs.

You’ll need to check with your doctor for a breakdown of all the costs before the selected procedure. Some facilities may provide a payment plan option.

Costs of a panniculectomy

A panniculectomy is far more expensive out of pocket, ranging from $8,000 to $15,000. This may not include other associated costs, such as anesthesia and hospital care.

Many medical insurance companies will cover a portion of this procedure. This is especially the case if your doctor thinks the panniculectomy is medically necessary.

You’ll want to call your insurance company ahead of time to see how much they’ll cover or if you’ll need to work with a specific surgeon.

Another consideration is the cost of taking time off work. It can take up to eight weeks to recover from this procedure.

Costs of a tummy tuck

While a tummy tuck is the cheaper option of the two procedures, it’s usually not covered by medical insurance. This means you could end up spending around $6,200 out of pocket, plus any additional medical service fees.

Like a panniculectomy, you’ll need to spend time off work or school after a tummy tuck surgery. Since this surgery isn’t as extensive, you’ll spend less time in recovery.

The average recovery time is about four to six weeks. More or less recovery time may be needed depending on the incision number and size.

Like any type of surgery, both panniculectomy and tummy tuck can cause immediate discomfort, along with a risk of side effects. Some of these effects are common, while others are rarer and require further medical attention.

Side effects of a panniculectomy

It’s common to experience pain for the first few days post-surgery. Your skin may also be numb, and the numbness can last for several weeks. The numbness is from the two areas of skin being sutured together after removing the excess skin between them during surgery.

Fluid retention is another possible side effect that may be minimized with drains inserted into the stomach after surgery.

Additionally, you may not be able to stand up straight for a week or two due to the healing process.

The following side effects are rare, and may require emergency medical attention:

infection
heart palpitations
excessive bleeding
chest pain
shortness of breath

Side effects of a tummy tuck

Immediate side effects of a tummy tuck include pain, bruising, and numbness. You might feel slight pain and numbness several weeks later.

Rare but serious side effects include:

infection
excessive bleeding
anesthesia complications
deep vein thrombosis

Below is a breakdown of the primary similarities and differences between these two procedures. Consult your doctor for further details, and to see which surgery is best for your own circumstances.

A tummy tuck or abdominoplasty may make sense if your lower abdominal walls are weak or when you have lots of loose skin around your belly button area and it bothers you a great deal. It is different from a panniculectomy, but both work on excess skin in the abdomen area.

If you are considering a tummy tuck procedure, it helps to understand how to get a tummy tuck approved by insurance. But first, you need to understand panniculectomy because it may be key to getting some insurance coverage.

A panniculectomy is a procedure that is meant to remove excess skin, usually stemming from significant weight loss, and is considered a medical procedure. On the other hand, a tummy tuck also includes the tightening of your stomach muscles, thus helping you contour the waistline. Therefore, the latter is considered a cosmetic procedure.

Read More: Health Insurance Basics

If you are still in the process of losing weight, you should wait until you have achieved or nearly achieved the size you desire before considering a tummy tuck.

It is worth noting that a tummy tuck is a bad idea if your physical health is compromised, you smoke, have unstable weight and have unrealistic expectations of what the surgery can do for you. In addition, you don’t need to have the cosmetic procedure if you aren’t bothered by how your body looks.

Unfortunately, even if you are an excellent candidate for a tummy tuck, you may not be able to afford it.

Even a mini tummy tuck is expensive, costing anywhere from $8,000 to $10,000. Should you opt for the more comprehensive cosmetic surgery, expect to pay as much as $20,000.

For this reason, you need to find a way for your health insurance company to pay some or all of the cost of your cosmetic surgery.

Most insurance companies consider tummy tucks as cosmetic procedures and thus medically unnecessary. Below are tips you can use to get some of your tummy tuck costs covered by insurance.

Health insurance companies consider panniculectomy a medical procedure, which means they will cover it. It is usually more expensive than a regular abdominoplasty but cheaper than the expensive version. Since they are similar in some ways, you could ask a cosmetic surgeon to break down the cost of the panniculectomy part and the remainder, which would be under the tummy tuck.

If you can get your doctor to recommend the medical procedure, the insurance would probably cover most of your costs. You can pay for the rest out of pocket.

Reports show that a tummy tuck can reduce issues of incontinence and back pain, especially in women who have given birth. So, if you have these issues, talk to your doctor.

If there is proof that surgery would help reduce or eliminate these problems, your health insurer may have no choice but to provide coverage for the solution. It just so happens that the solution will come in the form of a tummy tuck.

You can also try to claim insurance for a tummy tuck as a solution to ventral hernia and the inability to walk properly.

Read More: What Is the Major Purpose of Health Insurance?

Most insurance plans – both private and public – do not cover elective surgeries because they consider them medically unnecessary. However, if your doctor recommends surgery as the solution to an underlying problem, such as incontinence and back pain, that cosmetic procedure becomes medically necessary.

Once that happens, it is much easier for you to get your health insurer to pay some or all of your tummy tuck surgery costs. So, talk to your insurance company people and discuss the issue with your doctor. If you have an underlying medical problem, your chances of getting help from insurance coverage are better.

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