When is a panniculectomy covered by insurance?

What are the requirements to qualify for a panniculectomy under my health insurance? What do I have to say to convince an insurance company to cover my surgery?


F, 44, Nevada

Tags:woman age 35-44 insurance

Good day! A panniculectomy is elidgible for insurance coverage if it is deemed a medical necessity, when the underlying problems affect your health and your quality of life.

My panniculectomy was covered by my insurance company. When my massive weight loss created excess skin and fat that hung at my lower abdomen, a panniculectomy was really necessary. I had a bunch of physical issues like skin infections, fungal infections, lower back pain and my ability to walk was limited. My surgeon said that insurance companies frequently cover the cost of panniculectomy surgery when hanging skin causes health issues. I'm not sure if insurance coverage applies to all plastic surgeons though. You might want to speak with insurance company.

Since having the surgery, I look and feel so much better, and I am much more confident. I had physical therapy after the surgery that helped to strengthen my muscles and decrease the back pain. My surgeon said that if the insurance company didn't cover the treatment, they have payment options.

My panniculectomy surgery was not covered totally by insurance. However, I did have a medical reason. It basically was preventing me from running and I had begun to have back issues because of my weight gain. The panniculectomy was part of three surgeries to help me remove the fat. The first was a stomach sleeve procedure (bariatric surgery) to help me lose weight, and then after I had excess skin and fat, the removal of the pannus was the next step. Most insurance policies do not cover panniculectomy surgeries unless it’s connected to weight loss I think. At least this is what it was for me. My friends who have tummy tucks and panni surgeries said that I was lucky to have mine covered by insurance at all, because it’s filed under plastic surgery for most cases.

I think you have to talk to your doctor. In my case, I was at a weight level that was really healthy and killing me slowly. My doctor recommended that I have the surgery since I had other issues losing weight because of a previous c-section, diabetes and hypothyroidism. The c-section was the part that got me the medically necessary recommendation and got my insurance to pay for it. If you get your doctor’s help, then I think insurance companies have to pay for at least part of the procedure if considered medically necessary. Good luck, ask me any questions. My surgery was several years ago, and it’s been a journey. I’m so glad to have the stomach I have now!

A panniculectomy should typically be covered by insurance given that's it's more often than not a medical necessity. Usually patients that require a panniculectomy struggle with day to day tasks such as cleaning themselves, as the excess skin gets in the way. This can be debilitating and therefore cause a lot of suffering to the patient's ability to live a normal life with proper mobility. Insurance companies are more inclined to cover these surgeries since panniculectomy is only really performed for the purposes of helping someone get back to a state where they can move and behave independently. Requiring assistance to complete day to day tasks is a strong enough indicator to insurance companies that panniculectomy should be covered. Have a conversation with your health insurance provider explaining why a panniculectomy is vital to your ability to live a healthy, positive lifestyle without letting illness get in the way.

Did you start off with a primary physician or a plastic surgeon?

Because panniculectomies are considered to be a cosmetic procedure, they are not covered by insurance. However, I was able to show that my procedure was medically necessary. I had to have my surgery approved by my insurance company before I was able to schedule the surgical procedure. My surgery wasn't based on how I looked. I hated the way my extra skin hung on my lower abdomen, but the skin was causing me to have health problems. I was dealing with skin rashes and the excess skin was affecting my mobility. I was also having the breakdown of skin that was causing some of my most severe issues. As I stated earlier, insurance companies will not cover cosmetic procedures. However, my doctor and I were able to document the issues my health issues. My procedure got approved by the health insurance provider. It's important to say that insurance companies have their own set of rules for approving procedures.

Did you go to a primary physician to start the process or a plastic surgeon?