American Society of Plastic Surgeons
For Medical Professionals
 
ScytheCyndel86
4 years ago
Answered

After insurance approves tummy tuck does a letter of payment is asked

Sorry if the question is confusing

So my insurance approved my tummy tuck but the surgeon wants a written letter from the insurance that states payment will be made. I have done all pre op test and I already had one surgery date canceled I been approved since July 2018 still no surgery. Help me understand how can I get my surgery asap.

Procedure: Tummy Tuck
Location: Yonkers, NY

Replies 4

Jeremy Sanderson
ASPS Surgeon

The problem is not with your surgeon, it’s with insurance companies in general. They agree to pay for some procedures and even give pre-authorization only to refuse to pay once the surgery is complete. I have been burned enough times, I don’t even try to get insurance to cover tummy tucks or breast reductions any longer. I ‘m truly sorry you’re having to deal with it. We all know it’s frustrating. Insurance companies make hundreds of millions of dollars in profits every year, but continue to do stuff like this. Good luck!!

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Gary Culbertson
ASPS Surgeon
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The issue most likely is your understanding of the verbiage utilized in Plastic Surgery. Let me try to explain. A “Tummy Tuck” is a laymen term for what is commonly referred to as an Abdominoplasty. This procedure commonly includes tightening the abdominal musculature loosened/ stretched during pregnancy, liposuction of the patients flanks & removal of the excessive lower abdominal skin. An Abdominoplasty is an Aesthetic or Cosmetic procedure that is not a covered service by almost all insurance carriers. A second procedure that can be covered by an insurance carrier is called an panniculectomy. This procedure involves the simple excision of the patients lower abdominal skirt of skin called a pannis. These are two entirely different things, like two different parts to a car have different code numbers and costs are significantly different. I like to tell my patients that it is like comparing a VW bumper to that of a Rolls Royce. Best,

Gary R Culbertson, MD, FACS

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Anthony Admire
ASPS Surgeon
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I don't believe the insurance will be able to provide that for your surgeon. There is never any guarantee of payment from an insurance company. Certainly one surgeon, or any physician can dictate what insurances do. If the insurance denies payment, then a lot of practices, including mine actually can collect payment from the patient if they sign an specific document. Best of luck though.

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Jon Ver Halen
ASPS Surgeon

Hello and thank you for your excellent question. This is a challenging question. Sometimes insurance will pay for a panniculectomy, but they generally do not pay for a true abdominoplasty. This is really something that needs to be addressed between with your insurer. If you have any questions, call our office for assistance. Good luck!

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