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TOPIC: Insurance to pay for Tummy Tuck??

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September 12, 2012 7:48 AM
Health insurance covers plenty of things that are a result of the individual's life choices, not just issues resulting from being overweight or obese, so it's not far fetched to think it would be covered. Being judgmental just shows your ignorance. Also, skin doesn't tighten the way most people think it does, especially as you get older, and even if you lose the weight slowly and in a healthy way while toning.
Edited by snailhead On September 12, 2012 7:49 AM
September 12, 2012 8:08 AM
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Very few people have enough of an issue to justify this medically. If you're searching for reasons, ultimately, you'd be committing insurance fraud. I work in the fraud arena, and these things are examined. People go to jail. Every day.

Don't do it. Save up your money if you want it done.

The only times I've heard of tummy tucks being covered is for those who had weight loss surgery. They get a one time surgery with some insurance plans.


I worked in a medical pre-certification office. We had a team of nurses and a medical director that determined the medical necessity of these kinds of procedures. It happens more often than one would think and it is NOT fraud if approved.

As stated above, there are many reasons that his could be approved for medically necessity. Irritation, rashes, infects from the overlapping skin, the excess skin causing stress on other bones or joints, etc.. Typically the requests we received were from plastic surgeons. They will send your medical records and a letter of appeal requesting this approval. Best of luck!


No, it's not fraud if it's approved by the company..unless of course you found a Dr willing to exaggerate or outright lie about your "issues". And yes, that happens. And it IS called fraud.
  7246266
September 12, 2012 8:09 AM
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Some gynecologists are doing them when patients have an abdominal hysterectomy so it is partially covered. Don't think that will help your hubby. lol Wish I haven't already had that surgery!


This is called a "cover procedure". Also can be viewed as fraud. We look for this to flag for medical review and recovery of dollars.
Edited by omma_to_3 On September 12, 2012 8:09 AM
  7246266
September 13, 2012 10:19 AM
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....I can never find clothes. EVER. I couldn't even tell you what size I wear. I have no idea. I try on 16, sometimes it fits, most of the time it doesn't. But at the same time... anything bigger, or even a 16 usually, may or may not fit my stomach but is WAY TOO BIG in all other areas..... I feel stuck. I can't go bigger because it doesn't fit in my thighs lol, but I can't go smaller bc it doesn't fit in my stomach. I just end up not buying anything! .....


I have had a tummy tuck and my clothes dont' fit properly either. My stomach is too small for my hips, so I have a hard time finding clothes. Having a tummy tuck may not make your clothes fit properly.....something to think about.
September 25, 2012 10:28 PM
I visited a general surgeon today who told me that I have an umbilical and ventral hernia. I also have diastasis recti (ab muscles are separated). He told me that he can take care of the hernias but not the diastasis. This is repaired by sewing the muscles back together and is done as a part of a tummy tuck. He says if I do not fit the diastasis, it will become worse as I age. He said that the weak stomach muscles can cause low back pain and have been connected with urinary and bowel problems. He says that ALL ab exercises are off limits until I get the diastasis repaired. Working those muscles makes it worse. I called plastic surgeons and they told me that they can (and often do) fix hernias while doing tummy tuck surgery. THe problem is NONE of the PS I called accept insurance. My insurance would pay for the hernia repair along. SHouldn't they pay for at least part of the surgery to fix all of it? I can understand them not wanting to cover the skin removal as that is cosmetic, but the rest is medically necessary. DOes anyone know who I can talk to about this?
  3406322
September 26, 2012 6:30 AM
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By the way - I should also post that I'm not just someone who uses google, I've been working in medical insurance claims for 7 years and know way more about it than I'd like to. I realize my answer is unpleasant, but that's the facts. Regardless of what doctor you go to, the insurance company uses their own doctors to make the final decision. You might get one that says it's necessary, but that does not at all mean your insurance company will pay for it.

HOWEVER....

Tummy tucks aren't all that expensive. If it really means that much to you, why not save up $3-5k? It's basically the cost of a nice vacation. It's your body. Do with it what you will. Just don't get mad when a HEALTH insurance company that is created for the purpose of alleviating expenses associated with keeping constituents HEALTHY, ALIVE, and STABLE does not consider it medically necessary. That is very, VERY American of you to even ask this question. And also is a great example of one reason health care costs in the US are so damn high.

That being said, I want a tummy tuck and a boob job. I plan to pay for it all by myself though...



I'm paying for my own as well... I already have 11k saved. lol I haven't found it for $3-5K yet.... My question was more if there was a way for insurance to cover part of the procedure. I have no issues paying for it myself, but if insurance was willing to pay for part I would take that! Its like a coupon :) lol Thanks for your replies tho! Very informative
  19861998
September 26, 2012 6:38 AM
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The OP is 33 years old and has been waiting for a tummy tuck for 17 years. (Do the math). I don't think you can look at a tummy tuck until you lose most of the weight...and your goal says you have some weight to lose). Why don't you start some lifting to tone up and see how you feel when you lose the weight?


One sane answer. In 17 years you had enough time to save the money. Second I can't believe you are asking how to do assurance fraud. Lastly lose the fat, give yourself one year or 2 for the skin to spring back the is a good amount of time to have a saving account.



Wow, someone woke up on the wrong side of the bed this morning. 1st of all, I have the money for a tummy tuck and then some. 2nd of all, I didn't get a tummy tuck in 17 years bc I wasn't done having children yet. 3rd of all, I'm not asking how to commit insurance fraud. I'm asking if I would be a candidate for having PART of my tummy tuck covered my insurance based on some of the issues I have. And lastly, I have lost "the fat" The problem is skin.
  19861998
September 26, 2012 6:45 AM
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why on earth does insurance cover people's laziness?


This. Your extra skin is because of what YOU did and I think it's BS you're looking for insurance to cover it.


Are you kidding me? How ignorant are you??? It's genetics, not laziness.

My mom had serious extra skin from childbirth. She worked out regularly with a trainer for YEARS, had VERY low body fat % and still had excess skin as us kids became adults. It is in our genetic make-up, my mom and I have no elasticity in our skin and no amount of working out or eating right will change that. She had a tummy tuck, which I will never have because of how horrified I was with helping my mom through the procedure. I would rather live with the flap of skin hanging down than go through what I witnessed.


Seriously? Not a medical necessity. Did you read the OP's profile? Probably not. She still has 40 pounds to lose. So maybe if she went at it the right way she wouldn't need said surgery. Trying to get insurance to pay for it is a scam. It's not an injury and it's not life threatening.



HAD 40 lbs to lose. I've lost 25 lbs. I plan on losing the other 20-25 by March/April of next year. (When I plan on having my tummy tuck) The whole point of me being here is to get the best body I can BEFORE having surgery. If I wanted to cheat the system and myself, I would have had the surgery 1st without trying to get healthy.

Getting insurance to pay for part of it IS NOT A SCAM. You don't make the insurance rules... the insurance people do! If they say they will cover it under certain circumstances than who are you to call it a scam?!
  19861998
September 26, 2012 6:47 AM
QUOTE:

QUOTE:

QUOTE:

QUOTE:

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why on earth does insurance cover people's laziness?


This. Your extra skin is because of what YOU did and I think it's BS you're looking for insurance to cover it.


Are you kidding me? How ignorant are you??? It's genetics, not laziness.

My mom had serious extra skin from childbirth. She worked out regularly with a trainer for YEARS, had VERY low body fat % and still had excess skin as us kids became adults. It is in our genetic make-up, my mom and I have no elasticity in our skin and no amount of working out or eating right will change that. She had a tummy tuck, which I will never have because of how horrified I was with helping my mom through the procedure. I would rather live with the flap of skin hanging down than go through what I witnessed.


Seriously? Not a medical necessity. Did you read the OP's profile? Probably not. She still has 40 pounds to lose. So maybe if she went at it the right way she wouldn't need said surgery. Trying to get insurance to pay for it is a scam. It's not an injury and it's not life threatening.


First, my mom paid for hers out of pocket. In all cases, no it is not medically necessary but it can be in some. My point wasn't in regards to the medical necessity anyway, but the fact that excess skin is NOT a result of laziness. You can not blame that on laziness, when skin elasticity is a genetic issue. I've seen these cases, I seen photos of patients with disgusting, painful blisters under their overlapped skin that were approved for the surgery. Those cases were determined to be medically necessary per the requirements listed previously.

Do you think that people should not be approve for eye lifts as well? They should be blind because their eyelids sag to where they can't see, after all it's laziness...



Thank you .flowerforyou
  19861998
August 9, 2013 1:33 AM
Insurance companies see it as elective. If there is one that does not your doctor would have a better grasp. But you can not just sign up for insurance and then get an operation. It is not designed to work that way.

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