Will Insurance Cover My Abdominal Panniculectomy?
Q: Dr. Eppley, I need to have a pannciuectomy. I had weight loss surgery in November 2010. I was originally 375lbs and I lost over a hundred pounds. I have had this overhang since I was in my teens and it now hangs to touch my upper legs. Will my insurance pay for it? My out of pocket expense is met for this year so surgery should be paid in full. Please please can you help me?
A: Many overweight people have a large abdominal overhang initially that is then aggravated by their weight loss. As the weight comes off and the ‘balloon deflates’ so to speak, this skin overhangs worsens and sags lower as it has lost volume. This creates complete obliteration of the groin creases and their pubic and genital regions creating the well known hygiene and skin irritation issues. As you have described, your abdominal pannus now hangs down completely into your thighs. By definition, this is one of the criteria that insurance uses to determine coverage.
While I would agree that it sounds like your panniculectomy would be covered by insurance, my opinion is irrelevant and is meaningless from the insurance coverage perspective. This is why we always file a predetermination so the insurance company has enough information for them to make a decision. It is their decision not mine. As a plastic surgeon, I am merely a vehicle by which I can help the patient be put in a position so their insurance company can make an accurate review and determination. This predetermination involves a written letter by me describing your condition, the problems that it is causing and photographs which show the size of the abdominal pannus. That is mailed to them and then you await a written response as to their decision about coverage for your abdominal panniculectomy.
Dr. Barry Eppley