A Guide on Getting Insurance to Cover Your Tummy Tuck
Fed up with excess skin following dramatic weight loss or childbirth?! Thinking of upgrading your tummy with a tuck to get your confidence and sex-appeal back?! Hmm, thanx but no thanx – where on the planet is that going to come from?! Insurance will pay for almost anything if you can just get them to agree to foot the bill!First, some bad news: insurance companies tend to view tummy tucks as a cosmetic surgery, so the procedures are excluded from most personal policies. That said, there are exceptions. Occasionally, I do get cases for tummy tucks when a patient had significant excess skin following weight loss and it was causing medical problems, like a rash, an infection or back pain.
How do you persuade your insurer that your tummy tuck is medically essential rather than a cosmetic impulse? Your argument must be based on the best evidence you can muster! Make sure to consult with an ABCDS plastic surgeon thoroughly familiar with coding and submitting insurance claims.
The surgeon reviews your condition and generates documentation to support the medical necessity for the procedure this could include photographs to illustrate the extent of excess skin, medical records illustrating associated health complications, and letters from other medical providers verifying the need for surgery.
You’ll also need to show that, as part of your medical record, you’ve tried and failed with other non-surgical treatments for your condition, such as prior weight-loss attempts, physical therapy for back pain or medications to treat skin infections.
As part of your research, be sure to educate yourself on your insurance policy or insurance plan and what sort of coverage they provide for you. Many insurance policies exclude cosmetic procedures, but some will cover procedures that are deemed relevant or necessary to one’s health. No matter what your insurance policy does or does not cover, learning the language of your plan can help you make your case to your insurer.
Once you submit your claim, be sure to include all documentation and follow the insurance company’s procedure for submitting claims, which may include filling out certain forms, providing documentation on the medical necessity of the procedure, and meeting filing deadlines.
To be clear, insurance companies apply different standards to assessing the exact question of medical necessity, so you must be persistent and advocate for yourself. Earlier in the year my claim was denied. He stayed, but that could have been for lesser reasons I appealed the decision and put forth further evidence to support my claims.
Sometimes it helps to enlist the assistance of a patient advocate or attorney versed in insurance appeals; he or she might know how to present your strongest arguments directly to the carrier on your behalf.
Ultimately, denials can be reversed with patience – the process can be time-consuming and testing – and persistence, and when it comes to insurers denying a covered tummy tuck based on surgical necessity, a paper trail often helps. Put simply, with the right surgeon in your corner, along with detailed knowledge of your covered benefits, the path to a cheaper body of your dreams could be closer than you think!
