Is A Tummy Tuck Covered By Insurance?

That is one of the most frequent questions asked when talking about the surgery. Most people know that in the United States the simple answer is NO. Insurance companies only pay for “medically necessary” procedures which a tummy tuck is not. Some people try to get them to pay for part of the costs by combining it with a secondary operation such as a hernia repair. In such cases they may have limited success.

Some people try to trick the company to pay for at least a portion of their operation by stating that they have a medically necessary procedure they need performed (such as a minor hernia repair or breast reduction surgery) which can be performed at the same time as their tummy tuck. Since the hernia repair surgery requires anesthesia and the operating room anyway why shouldn’t these costs be covered by their insurance? Some take great lengths in trying to convince the insurance company by..

1. Going to their primary care physician for an examination to see if they have any tummy related area problems that need surgery to correct them, if it is possible to combine the surgery and if the physician will be willing to provide the insurance company with the appropriate supporting documentation.

2. Go to their plastic surgeon for an examination and to see if it is possible to combine the surgery with a tummy tuck operation and if the surgeon will be willing to provide appropriate supporting documentation.

3. Investigate whether their policy provides any coverage for the surgery.

Related Operations

1. Hernia Operation
   Individuals who want a tummy tuck but also have a have a hernia often ask if they can have a combined operation in order to avoid a second surgery and to save money by having their insurance company pay for the hernia portion of the operation. Tummy tucks are usually not covered by insurance in the United States, while surgery for a hernia is.

2. Breast reduction operation

This is an interesting excerpt about one person’s attempt at getting their insurance company to pay for an abdominoplasty surgery.

“Just wanted to mention that when I saw my Plastic Surgeon for a Breast Reduction through insurance we talked about the TT as well, and he said in the 23 years he has been doing this, only ONCE had an insurance company paid for a TT. I would recommend working with a surgeon who has a good track record of getting coverage, since then the Plastic Surgeon and the office staff can help you know what you need to do, and what specific documentation you will need. I decided to pay for mine out of pocket, since the docs I talked to were convinced I would see HUGE results (I have a 9cm split of the muscles) and am a good candidate, but none of the docs thought that going for coverage would work, since it is not “medically necessary” in my case.”
source: http://www.breasthealthonline.com/cgi-bin/mwf/topic_show.pl?tid=138583

QUESTIONS

1. Does insurance cover Tummy Tuck surgery cost?
   Usually it is not covered. A portion of the cost may be covered if there is a valid medical reason, but I understand that it is a rare occurrence. Ask your doctor if he can provide the “required medical reasons” then check with your insurance company. Consider your deductible amount and the possibility of a future rate increase (because of the operation) with your insurance company when you analyze your costs.

2. When does insurance cover the cost of a Tummy Tuck?
   Generally it does not cover elective cosmetic surgery. There may be cases in which they will cover a portion of your medical costs. These include having a hernia corrected through the procedure or if you have had surgery for weight loss.

3. When should I call my insurance company?
   Calling should be one of the first things you do. When you call to inquire about coverage be sure to ask them if your policy covers the cost of surgery, the cost of anesthesia and hospital costs. Also ask them if there will be an increase in your premiums and if your future coverage will be affected in any way.