Will My Health Insurance Pay For An Abdominal Panniculectomy?

Q: Dr. Eppley, I am interested in a tummy tuck which is needed after my bariatric surgery. After my bariatric surgery I’ve had this horrible itching and burning under my skin flap over my c-section scars. Do you thing my insurance would help pay for me to get a tummy tuck? I am too embarrassed by my body to swim or dress in front of anybody. It really is horrific on my life.

A: For the sake of clarification, you are specifically asking about an abdominal panniculectomy not a tummy tuck. An abdominal panniculectomy is a potentially medically indicated procedure to treat a flap of overhanging skin that causes dermatologic problems underneath it due to chronic moisture. A tummy tuck is a purely cosmetic procedure that removes loose abdominal skin and fat that may or may not have some waistline overhang.

Only your health insurance company can truly answer the question of whether an abdominal panniculectomy would be a covered procedure. That needs to be obtained through what is known as a predetermination process. This involves a consultation from a plastic surgeon from which a predetermination letter with picture and medical documentation would be submitted. From this information, your health insurance company will then determine whether they authorize coverage.

While only the insurance company can make that decision, there are very specific criteria that they look for in determining that eligibility. Without all of them, it will most assuredly be denied. They include photographic documentation of an abdominal pannus that hangs over the groin crease onto the upper thighs, photographic documentation of redness/skin irritation under the abdominal pannus, and medical records that demonstrate there has been a history of skin infections that have been treated by topical methods that have recurred despite these treatments.

Dr. Barry Eppley

Indianapolis, Indiana