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Can a Tummy Tuck be Covered by Insurance?

Getting plastic surgery may sound like an indulgence to some. But the reality is that not all plastic surgeries are created equal. In fact, what may seem purely cosmetic to one person, may prove medically necessary to another. Such is the case when it comes to a tummy tuck, also known as an abdominoplasty.

What is a Tummy Tuck?

A tummy tuck is a procedure in which excess abdominal skin, including the attendant layers of fat, are removed. The results of this procedure allow for a slimmer, more streamlined abdominal profile which is in part, one of the reasons this procedure is so often pursued. Essentially, tummy tucks take care of what weight loss and exercise simply cannot. Though actual weight is lost when skin is removed during an abdominoplasty, the procedure is not intended to be used as a bariatric or surgical weight loss technique.

The Medical Benefits of Tummy Tucks

In March of 2018, an article published in Plastic and Reconstructive Surgery, the Journal of the American Society of Plastic Surgeons, stated that abdominoplasty can be quite helpful for women who have recently experienced vaginal births, and individuals suffering from urinary incontinence and severe back pain. It seems that repair of the abdominus rectus muscles not only makes people look thinner, but helps to support and strengthen muscles that may have separated (diastasis) after a vaginal delivery. In addition, tummy tucks have proven therapeutic in the treatment of urinary incontinence and excruciating back pain.

Insurance Coverage of Tummy Tucks

Tummy tucks that are considered purely cosmetic in nature are, unfortunately, not covered by insurance. What most insurance companies do not take into account is the fact that individuals seeking this procedure are often pursuing constructive ways to improve their appearance. Sadly, the reality that poor body image can spur feelings of body dysmorphia, depression, and other forms of emotional dissonance, is not clinically valued. And despite research that states, and in fact proves, that an abdominoplasty can also alleviate back pain, strengthen the muscles that support the back, and significantly improve quality of life for patients who suffer from urinary dysfunction, this procedure is still largely seen as nonessential.

Can a Tummy Tuck be Covered by Insurance?

While there are patients who are willing and have the means to pay for a tummy tuck out of pocket, there are many who simply cannot. If there is a documented medical, as opposed to cosmetic need for the procedure however, there is a chance that insurance will cover the cost.

Conditions for Medically Necessary Tummy Tucks

Based on the fact that insurance will often pay in part or in full, for a breast reduction in order to ameliorate back pain, there does exist the possibility that some insurance companies will approve tummy tucks in Raleigh, North Carolina for the same reason. This is because untreated back pain, whether the result of weak abdominal muscles, excess skin, or another diagnosis, can lead to complicated medical conditions, whose treatment will not be cost effective in the long run.

Other conditions for which insurance companies may approve tummy tucks, include hernias, both incisional and umbilical. Patients who have undergone bariatric weight loss surgery or lost large amounts of weight non surgically, may also be candidates for coverage of an abdominoplasty. This is because the excess weight prior to weight loss and the excess skin post weight loss, can cause dermatological issues, increase the likelihood of back pain, and cause other internal, structural damage within the abdomen. In short, it always pays for patients to discuss abdominoplasty with their doctors in order to determine if their procedure may in fact be covered by insurance.

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Susan Paige

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