Will Insurance Cover a Tummy Tuck?

A tummy tuck, also known as an abdominoplasty, is one of the most popular plastic surgery procedures in the country because it can help resolve common issues facing patients who have been pregnant or lost significant amounts of weight.

Even though a tummy tuck is an aesthetic procedure, it can provide legitimate functional  benefits. For this reason, many patients hope their surgery will be covered by insurance.

However, whether tummy suck surgery will or will not be covered depends on the answer to a number of questions.

Tummy tuck vs. panniculectomy

Sometimes patients use the terms tummy tuck and panniculectomy interchangeably, but they are actually two different surgeries.

To understand the difference between the two, it is important to understand what can happen to the muscles and skin of the abdomen during pregnancy or after losing or gaining significant weight.

First, the rectus abdominis muscles can separate along the midline of the abdomen, an anatomical landmark known as the linea alba that connects them. This creates a condition known as diastasis recti. Severe tears will not heal on their own and require surgery to be repaired.

Second, pregnancy and weight gain can cause abdominal skin to be stretched enough that it will not be able to return to its original shape, regardless of changes in diet and exercise.

Together, torn muscles, extra skin, and excess pockets of fat form what is known as a pannus. Also known as an apron belly, the size of a pannus stomach can vary widely, from hanging just to the top of the pubic area to hanging to the upper or mid-thigh.

The difference between a tummy tuck and a panniculectomy is how they treat the removal of a pannus.

A tummy tuck, or abdominoplasty, is almost always an aesthetic procedure in which excess skin and fat are removed from the abdomen and abdominal muscles are repaired and tightened.

By contrast, a panniculectomy is primarily focused on removing excess tissue t from the lower belly area after significant weight loss. Underlying musculature is not involved.

The type of surgery you will need depends on your medical history, whether or not your stomach pannus is causing significant hygiene issues, and your aesthetic goals.

What qualifies you for a tummy tuck?

The best candidates for a tummy tuck are generally healthy non-smokers who are fairly close to their ideal body weight and have stubborn pockets of fat or extra skin on their abdomen that are resistant to changes in diet and exercise. Patients with significant diastasis of the rectus muscles also benefit from the cosmetic and functional improvements of this procedure.

Patients should have realistic expectations for their results and be seeking this surgery for themselves. A tummy tuck is a major surgery that should not be influenced by the opinion of  anyone except yourself.

Will insurance cover my tummy tuck?

Most insurance plans will pay for a panniculectomy, but they will not cover the costs of a tummy tuck. This is true even for patients with diastasis recti and a mild to moderate pannus stomach because tummy tucks are considered an aesthetic procedure and include muscle repair by definition.

But even though your insurance plan will likely not pay for an abdominoplasty, there is a possibility they will cover part of the procedure under certain circumstances.

Back pain

Patients with a diastasis recti may have low back pain that significantly impacts their daily lives, especially when it is combined with excess skin and fat on the abdomen. In some cases, this pain persists despite exercise, physical therapy, massage or chiropractic care, and other medical interventions.

In this situation, some insurance companies may cover the diastasis repair or excess skin removal under the same rationale used to cover breast reductions.

Hernias

Diastasis recti can cause ventral or umbilical hernias. Because hernias can cause constipation, abdominal protrusions, nausea, pain, and even sepsis, it is possible for insurance to cover the hernia and diastasis repair as part of a tummy tuck.

Rashes or ulcers

If your pannus stomach hangs over your pubic bone, the constant contact and friction between your skin and the underside of the pannus can cause rashes, skin ulcers, and infections that cannot be effectively treated without removing the excess skin. In these situations, your insurance may not cover the diastasis repair but may pay for the removal and tightening of abdominal skin.

Incontinence or prolapse repair

In many cases, the lack of support provided by weak stomach muscles and loose skin can cause issues with incontinence and pelvic organ prolapse.

For some patients, a tummy tuck can correct these issues or be combined with bladder or pelvic surgeries. While insurance will not cover the full cost of the surgery, it may pay for portions that address incontinence or prolapse concerns. In this case, your plastic surgeon may partner with a specialist to perform any necessary procedure concurrently.

Finding the right surgeon

The best way to determine if you are a good candidate for a tummy tuck and your potential insurance coverage is to meet with a Board-Certified plastic surgeon. Once a surgical plan is determined, your surgeon and their coordinator will be able to more formally discuss any insurance involvement.

An abdominoplasty requires a specialized combination of technical and artistic skills, which you are far more likely to find if you select a surgeon who is certified by the American Board of Plastic Surgeons. ABPS board-certified surgeons have consistently proven their ability to manage complex cases and deliver exemplary results thanks to years of rigorous training.

Additionally, you should look for a physician who has a substantial portfolio of before-and-after photos, a reputation for excellent patient care, and staff dedicated to helping you navigate your insurance coverage.

A tummy tuck is a major surgery, but the results can be life-changing with the right care.