Will my health insurance cover a tummy tuck?
“To sum it up…”
- A tummy tuck is called an abdominoplasty
- A traditional tummy tuck is almost never covered by health insurance
- A tummy tuck thins and strengthens the abdominal wall
- Only a physician can determine whether a tummy tuck is appropriate
- An abdominoplasty can cost anywhere from $4,000 to $15,000 in the US
In medical terminology, a tummy tuck is called an abdominoplasty.Under most circumstances, a tummy tuck is an elective or cosmetic procedure. The goal of a tummy tuck is to make the abdomen thinner and firmer.
To do this, a general surgeon will remove excess skin and fat from the lower and middle abdomen. The goal is that removing excess fat and skin will tighten the muscles and the abdominal wall fascia. Usually, a patient will seek this type of procedure when they have had significant weight loss or sagging skin after pregnancy.
Elective or cosmetic procedures are deemed not medically necessary by health insurance companies. Because the surgery is not medically necessary, it is not eligible for reimbursements, which means a patient must pay for the procedure out-of-pocket.
However, there are some medical conditions that may be considered by insurance companies for payment. Below, we will go over when a tummy tuck may be covered by insurance and when it may not.
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Medical Conditions Where a Tummy Tuck may be Paid by Insurance
Patients diagnosed with hernias may have a tummy tuck covered by insurance. Specifically, a concurrent epigastric umbilical, incisional, or a ventral hernia, may be eligible to have their procedure covered by insurance; or at least a portion of it.
Other conditions that may qualify a patient for tummy tuck reimbursement include severe birth trauma or serious skin breakdown.
If a tummy tuck is deemed necessary to correct a hernia, a general surgeon will complete the procedure. In this situation, it is necessary for the patient and doctor to fully disclose all details to the insurance company.
Other examples of medical conditions that may be eligible for insurance payments on tummy tucks include patients with an enormous pannus, which are large abdominoplasties, or in even simpler terms, a very large belly.
Patients who have undergone gastric bypass surgeries commonly suffer from abdominoplasties. However, the condition is usually only eligible if the patient suffers from back pain, rashes under the pannus, dermatitis, fungal infections, or cannot care for themselves’ — specifically the skin underneath the large belly.
A tummy tuck may also be considered for payment if the patient has had post-surgery massive weight loss.
Instances when a Tummy Tuck is Not Eligible for Payment
Most insurance companies specifically will not pay for the liposuction or diastasis repair component of a tummy tuck. But, when in doubt, a patient should seek a consult with an appropriate physician.
A plastic surgeon and general surgeon can evaluate a patient’s condition to determine whether a tummy tuck would be medically necessary.
Instances when a Tummy Tuck is Not Eligible for Payment
Most insurance companies specifically will not pay for the liposuction or diastasis repair component of a tummy tuck. But, when in doubt, a patient should seek a consult with an appropriate physician.
A plastic surgeon and general surgeon can evaluate a patient’s condition to determine whether a tummy tuck would be medically necessary.
Understanding the Cost Associated with a Tummy Tuck
When a patient visits a physician for a tummy tuck consult, it’s important to understand the costs associated with this procedure. In the United States, a tummy tuck can cost anywhere from $4,000 to $15,000 depending on how complicated the surgery is.
Factors that influence the cost of a tummy tuck include patient age, overall health condition, and weight. If a patient is considering a tummy tuck for purely cosmetic reasons, the patient should expect to pay for the entire procedure out-of-pocket.
Most doctor’s offices and facilities will require the surgery to be paid in full or have payment arrangements made in advance before it can be scheduled.
Tummy Tuck Recovery Process
Aftercare costs must also be considered including follow-up visits, facility fees, medications, and anesthesia costs. If the procedure itself is not covered, aftercare will not be covered either.
It’s also important to remember there is no absolute guarantee that a tummy tuck will be successful. If there are complications with the surgery, a second procedure may be required to get the desired appearance.
If there are complications with the surgery, a second procedure may be required to get the appearance the patient desires.
In conclusion, the only way to know if an abdominoplasty would be covered by your insurance is to have a consult with an appropriate physician. If a tummy tuck is not covered by your health insurance, your physician may be able to find a solution or alternative procedure that could eliminate your health concerns.
Enter your zip code below and compare health insurance quotes today! If you have a medical condition that makes you eligible for abdominoplasty coverage, we’ll match you with the best provider to insure your surgery and follow-ups.
