Abdominoplasty and Belt Lipectomy

Abdominoplasty treats stretched apart rectus abdominus muscles and loose skin above the umbilicus. As these issues do not cause skin infections in the fold under the pannus, they are always considered cosmetic and not covered by insurance. The same applies for loose skin of the flanks (belt lipectomy).

Unfortunately insurance companies are stingy. They only cover what they consider to be medically necessary procedures. You could try to write an appeal letter, but I have found that they have strict rules and typically don’t bend.

I suggest that you visit your doctor again and tell him about your insurance problem, if your doctor could give the medical certificate that your abdominaoplasty and belt lipectomy were medically necessary, then you might have your insurance company to cover the medical expense.

Thank you for sharing your question. Unfortunately insurance companies deem the other procedures to not be medically necessary and will not cover their cost.

There are different codes for the procedures. The pannulectomy is what covers the skin that gets irritated. It amputates the overhanging skin. Many insurance companies have very strict criteria just for the pannulectomy requiring medical treatment and overhanging the pubis by a certain amount. The other two procedures are a cosmetic improvement.

However, the cost may be less than you think if done as an outpatient as a cash prepay. Some patients find their copay and deductible and out of network costs for anesthesia more for just the pannulectomy, than the cost of a self pay abdominoplasty.

I sympathize with your desire, but unfortunately a lot of people would like an abdominoplasty covered by insurance. That is why a number of years ago the CPT code for pannulectomy which can be an insurance covered procedure, was separated from the abdominoplasty which is a cosmetic procedure. The fraud was excessive.