When is a Panniculectomy medically necessary?

Functional impairment is defined as complete or partial loss of function of a body part. panniculectomy should not be performed until at least 18 months after surgery and only after weight has been stable for the most recent 6 months. Abdominoplasty is considered cosmetic and therefore not medically necessary.

How do you qualify for a Panniculectomy?

Why is a Panniculectomy medically necessary?

Panniculectomy surgery may be indicated to reduce the panniculus. The surgery removes the excess skin and fat that hangs over the abdominal area. It may be indicated if the panniculus interferes with a person's daily activities (ADLs) and/or results in severe skin conditions that do not resolve after medical treatment.

Will medical cover a Panniculectomy?

Panniculectomy is considered not medically necessary when the criteria above are not met. Panniculectomy is considered not medically necessary as an adjunct to other medically necessary procedures, including, but not limited to, hysterectomy, or incisional or ventral hernia repair unless the criteria above are met.

What is a medically necessary reason for having a tummy tuck?

In flattening the abdomen and removing excess stomach fat, a tummy tuck surgically tightens the weakened muscles, resulting in much-needed abdominal support that can alleviate your back pain. To improve posture: A byproduct of stronger abdominal muscles and decreased back pain is improved posture.

Can a tummy tuck be medically necessary

What is the BMI for a Panniculectomy?

Reaches a body mass index (BMI) less than or equal to 30 kg/m²; or. Has documented at least a 100 pound weight loss; or. Has achieved a weight loss which is 40% or greater of the excess body weight that was present prior to the individual's weight loss program or surgical intervention.

How do I get insurance to cover a Panniculectomy?

Since the panniculectomy is not typically seen as a cosmetic surgery, your insurance provider may help pay for the procedure. But, you must meet specific criteria, and the panniculectomy must be seen as a medical necessity. Contact your health insurance provider to discuss your payment options.

Does insurance pay to remove excess skin after weight loss?

Insurance companies typically cover weight loss surgery, but don't always cover cosmetic surgery to remove excess skin after significant weight loss. Explore the issue of cosmetic surgery with your insurance company.

Do I need a tummy tuck or Panniculectomy?

They may both be performed in cases of extreme weight loss from natural or surgical causes. The goal of panniculectomy is to primarily remove hanging skin, while a tummy tuck also provides contouring effects to enhance your muscles and waistline. It's also possible to have both procedures done at the same time.

Does insurance cover tummy tucks ever?

In many cases, a tummy tuck is merely a cosmetic procedure, and most insurance plans will not cover this. However, if you are experiencing rashes or skin infections, it then becomes a medical need to have the surgery. In this case, you may be able to get some of the costs of your tummy tuck covered by insurance.

How much weight can you lose with a Panniculectomy?

In most cases, patients lose a minimal amount, typically under five pounds. Other patients with more extensive loose skin may lose between 5 – 10 pounds, and, sometimes, even more.

Is a Panniculectomy considered reconstructive surgery?

However, panniculectomy is considered reconstructive when performed to correct or relieve structural defects of the abdominal wall, irregularities or pain caused by prior pelvic or lower abdominal surgery, intertriginous skin conditions and scarring.

Does medical cover loose skin removal?

Though heavy, excess skin left behind after weight loss can be considered a medical condition due to discomfort and increased risk for skin conditions, most insurance providers do not cover body lift surgery.

How long does it take to get approved for a Panniculectomy?

information from your visit is sent to your insurance company for authorization. This process can take from 14-60 days. medical information, your insurance company will make the decision about whether to cover your panniculectomy.

How long is the hospital stay after a Panniculectomy?

You will need to stay at hospital for about two days after the surgery. You may need to stay longer if your surgery is more complex. After you recover from the anesthesia, you will be asked to get up to walk a few steps. You will have pain and swelling for days after surgery.

How much does it cost for a Panniculectomy?

Typical costs: A panniculectomy typically costs $8,500-$15,000, including the surgeon fee, anesthesia, facility fee and overnight stay in the hospital.

Is a Panniculectomy the same as a mini tummy tuck?

The biggest difference is the goal of the surgical procedure. A tummy tuck tightens the abdominal muscles and removes excess fat, skin, and tissue, while a panniculectomy is performed to remove a pannus.

Do Panniculectomy scars go away?

Like all surgical scars, abdominoplasty scars will never go away completely, but most patients feel they are well worth the benefits of achieving the smooth and flat abdominal contour they desire. Dr. Schlechter places the incisions as discreetly as possible to minimize scarring so that you can enjoy the best results.

Does Panniculectomy leave a scar?

All surgeries, including tummy tuck, leave scars along the incision line(s). Scarring is the body's natural response to a wound. Tummy tuck usually involves two incisions: one on the lower abdomen and one around the belly button.

When should you get skin removal surgery?

Does BCBS federal cover Panniculectomy?

BCBSNC will provide coverage for Panniculectomy when it is determined to be medically necessary because the medical criteria and guidelines shown below are met.

How much does it cost to get loose skin removed?

Excess skin removal surgery costs

These are the average costs for the most common plastic surgeries for loose skin after weight loss, according to the 2020 Plastic Surgery Statistics Report: Panniculectomy: $8,000-$15,000. Lower body lift: $7,924. Upper arm lift: $4,861.

What is included in a Panniculectomy?

A panniculectomy surgically removes a pannus. A pannus is excess skin and adipose (fatty) tissue, sometimes referred to as an apron, that hangs down over the genitals and/or thighs.

Does insurance cover tummy tuck for Diastasis Recti?

Surgery is an option, but is usually not covered by insurance since it is considered to be cosmetic; the surgical procedure most commonly used to treat DR is also known as a “tummy tuck,” used to make the abdomen thinner and firmer.

How do I get rid of Panniculus?

Surgical removal is the only way to get rid of the panniculus, which doesn't respond to diet or exercise. Although weight loss can help decrease the fatty deposits, extra skin often remains behind.