Does Insurance Cover Tummy Tuck Surgery?
When preparing for tummy tuck costs, many people wonder if they can expect their insurance to cover some of the total price. This blog discusses financially preparing for a tummy tuck, provides a general guide to insurance coverage, and discusses whether tummy tucks are eligible for insurance coverage.
Preparing for Tummy Tuck Costs
When choosing to get a tummy tuck, cost is one of the first things to prepare for. It is important to be aware of both the surgeon’s fee for the tummy tuck itself and also any additional costs, such as surgical facility fees, anesthesia fees, compression garments, prescription medications, etc. Navigating tummy tuck costs can be tricky, so it’s essential to plan ahead and determine how you will pay for your procedure.
Some patients save up as much money as they can prior to their procedure to cover the full or partial costs of tummy tuck surgery. Others may look into financing options or use a combination of personal savings and third-party financing.
How to Get Insurance Coverage
A question that many prospective patients ask regarding the cost of tummy tuck surgery is whether the procedure is eligible for insurance coverage. To fully understand the answer to this question, it is important to be familiar with how insurance coverage works.
Keep in mind that each insurance plan varies, so it’s a good idea to go to your insurance provider with specific questions about how they determine coverage. Generally speaking, most insurance companies require a surgery or treatment to be seen as medically necessary in order to cover some or all of the cost. The National Association of Insurance Commissioners (NAIC) states that medical necessity is determined on a case-by-case basis for different insurance providers, and policy language and state law can impact how medical necessity is defined.
Your insurance provider will likely require a letter from your doctor detailing why the procedure is necessary for your health and overall medical well-being. Your insurance provider may also perform a review process before, during, and after your procedure or treatment to determine, along each step, if it is medically necessary.
Is a Tummy Tuck Ever Eligible for Insurance Coverage?
There are some cases where tummy tuck surgery costs may be partially covered by insurance. Patients with rashes or skin infections due to significant excess abdominal skin that hangs over the body may qualify for insurance coverage. Those seeking a tummy tuck to repair diastasis recti may be eligible for coverage if they have medical problems due to separated abdominal muscles, such as lower back pain or poor posture. Additionally, a tummy tuck that is performed alongside hernia repair may qualify for partial coverage. Dr. David Pincus provides his tummy tuck patients with a physical exam during their consultation to determine if any of these medical situations apply.
So, can a full tummy tuck be covered by insurance? The short answer is that it is very unlikely for most insurance providers to offer 100% coverage for a full tummy tuck. This is mainly because tummy tuck surgery is seen as an elective cosmetic surgery and not viewed as a medical necessity. For many patients seeking tummy tuck surgery for its aesthetic and confidence-boosting benefits, it can be very difficult to make a case for the procedure being medically necessary.
Since every patient’s circumstances are unique, it’s important to discuss insurance eligibility with your surgeon, doctor, and insurance provider.
Schedule Your Tummy Tuck Consultation in Smithtown, NY
Ready to begin your tummy tuck journey? Allow Dr. David J. Pincus and our team at Pincus Plastic Surgery to walk you through your options and get you started on your dream results.
To schedule a consultation, call (631) 352-3556 or complete our online contact form.
