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Should Post Massive Weight Loss Surgery Be Covered Under Insurance

By Peter Fisher, MD on March 17, 2015


I broach this topic, as I believe it is both sensitive and controversial. Notice that I used the term surgery and not body contouring in my question. Therein, I believe lies the essence of this discussion.

If one looks at post major weight loss surgery as an artful challenge, which I do, then I believe it should be called, post major weight loss body contouring surgery and not covered by insurance. There are however plenty of exceptions to this which I will discuss later.

Insurance Coverages

On the other side of the coin, is to call it post major weight loss reconstruction and have insurance coverage for this. Many Plastic Surgeons advocate for this because of the associated medical problems these patients have secondary to overhanging skin. The major areas of concern for these are the excess skin of the abdomen (pannus), which overhangs the pubis, the excess upper inner thigh skin and the excess arm skin. If we deem these areas as medical problem areas that should and eventually are covered by insurance (they already are sometimes now), what procedures do we do for them? Do we perform full abdominoplasty’s and or Lower Body Lifts with associated liposuction? Do we do full arm and thigh lifts with associated liposuction to improve function or prevent skin eruptions?

Excess Skin

Should we not continue on a case by case bases, get approval when really necessary and perform the appropriate procedure for that area? That would be a Panniculectomy for excess skin and fat of the abdomen. This is removal only of that portion of skin and fat that overhangs the pubis and or has skin disease within. It does not include any tightening of the underlying muscle fascia, nor belly button repositioning. It may well result in the removal of the belly button. It does not include any liposuction. It is NOT a body contouring procedure. If the excess skin of the arms and or the legs does get covered, then I would suggest as I do now, perform the procedure that will improve the patient’s function or alleviate their medical problem. All of these will obviously improve the contour for the patient but will not give them the esthetic result that they may really want, but did not share with you.

All some patient’s want, is to remove the excess bothersome skin. Then what I described above is appropriate. Let’s try our best to get this covered and perform the appropriate procedure. Some patients however are confused about the medical nomenclature and think that a panniculectomy is a tummy tuck and sometimes even a lower body lift.

Patient Groups

What I try to do is to separate my patients into three groups:

1. Those that want to improve their appearance.

2. Those just wanting the excess skin and fat removed for medical reasons.

3. A combination of the above.

Reducing Costs

Patients who want to look and feel better about themselves, but who feel that a lot of the excess tissue is resulting in medical issues. These are the patients that sometimes get confused with what is covered and what is not. If I feel that there is a reasonable chance that the insurance company will cover the patient’s problem, such as their excess skin and fat of their abdomen, I will take appropriate photos and then submit a letter of approval to the insurance, for what would be in this example, a panniculectomy. If it is approved, then some of the costs of the lower body lift, which includes a panniculectomy, will be covered, thus reducing some of the patient’s costs.

Let me again explain, as unfortunately I’ve seen this described many times on the internet and on some Plastic Surgeon’s web sites, a panniculectomy is not an abdominoplasty, nor is it synonymous with one.

A Panniculectomy is the removal of excess skin and fat with or without removal of the belly button only. The patient will look and feel physically better after this procedure, but there are no active measures to perform any contouring improvements, which would be the main goal of a lower body lift or abdominoplasty (tummy tuck), being performed for esthetic reasons.

Abdominoplasty

A lower body lift or abdominoplasty consists of removal of excess skin and fat, muscle plication and in my practice as well as most other Plastic surgeons practices, liposuction, all together, so that the best possible cosmetic result can be obtained. These are my opinions only but hopefully will help potential patients more fully understand their options regarding post massive weight loss surgery.

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Dr. Fisher has been available to answer all of my questions and provide me with not only professional medical expertise, but also a much appreciated level of personal empathy. I would 100% recommend Dr. Fisher to anyone who is considering plastic surgery.

Brandi

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