Will Insurance Cover My Abdominal Panniculectomy?
Q: Dr. Eppley, I am wondering if I am a candidate for an abdominal panniculectomy procedure. What I mean by being a good candidate is whether insurance will pay for the procedure. removal. I am not sure if I am a grade 2 or 3 pannus.
A: Only your insurance company can truly answer the question of whether an abdominal panniculectomy would be covered but the basic criteria are:
1) an abdominal pannus that covers the groin crease and hangs onto the thighs,
2) an abdominal pannus that is associated with recurrent groin crease skin infections that has a documented three month history of topical skin treatments (non-surgical therapy) that has failed,
3) a BMI of less than 30 or a body weight that in within 20% of their ideal body weight based on standard height and weight measurements.
If one does not fulfill all three criteria, my experience has been that approval for abdominal panniculectomy surgery will be denied. And in some cases, even if all three criteria are met, a denial will still be given. It is also important to check whether your insurance company has a policy exclusion for panniculectomy surgery, as many companies now do, so this may not be a surgical procedure that is even eligible for coverage.
Dr. Barry Eppley