How to Get a Tummy Tuck Approved by Insurance

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.

​Read More:​ Help With Eye Surgery for the Uninsured