Question:
DOES ANYONE KNOW WHAT IS NORMALLY CONSIDERD MEDICALLY NECESARY TO GET TUMMY TUCK,ARM

   — EVELYN P. (posted on August 27, 2004)

August 27, 2004
With panniculectomy or tummy tuck the skin usually has to hang down over the pubis area - they also consider if you have rashes or hygiene issues with this. While I'm sure someone somewhere may have gotten arms covered, here in the state of Alabama there are no circumstances where insurance will pay for "bat wings". Sorry I can't help you in that area. Best wishes to you!
   — ronascott

August 27, 2004
Ditto Rona's answer. I would also add that insurance often covers only a panniuclectomy, and not a full tummy tuck. The panniculectomy is the removal of the extra skin. Abdominoplasty involves tightening the underlying muscles. That is very often considered cosmetic, as are the arms (we might have a "mentally-necessary" issue, but insurance rarley considers it medically-necessary. The key is to document all problems that the extra skin is causing (rashes, infections, back aches, what have you). Get them into your medical record for proof. Also, when you get to the point of looking for a plastic surgeon, get one who is willing to work with insurance (many are not). That improves your chances of getting a medically-necessary determination.
   — Vespa R.

August 27, 2004
What the other posters say is accurate, however it is possible to get an abdominoplasty covered when it relates to back problems. My insurance covered a full extended abdominoplasty done in two stages. All of the excess skin below the navel was removed in the first surgery and as much as he could above the navel. The 2nd surgery basically did a panniculectomy above the waist all the way around. After both surgeries I am cut 360 degrees at the panty line and at the bra line as well as an anchor cut up the center. Before the 2nd surgery I had very large blobs of skin on the back, under the bra line, to the waist as well as some excess hang left in the front, although he was able to remove a lot more in the front with the first surgery than he ever thought he could. My situation was that the waist has always been extremely anchored down and therefore that skin did not stretch nearly as much as everything else. This meant that the PS could not get under the skin, loosen it up and pull it all down like they normally do. Each area had to be dealt with separately. The first surgery removed 19 lbs and the 2nd one about 3 lbs. Along with each surgery I had additional work done that I paid for. With the 1st surgery I paid for the lateral thigh lift portion so that the end result was a complete lower body lift. With the 2nd surgery I paid to have a bunch of fat (4 liters) lipo'd out of my upper legs in preparation for the skin removal later this year. As saggy as the legs are now with a lot of fat gone, I knew they would get worse before getting better, I like my legs more now because they have closer to a more normal shape. I carried a lot of the fat in my legs right above the knees. That's still where the excess skin etc. accumulates now but it just looks better - trust me. <p>I have a long history of low back disc problems and with a well written letter from an orthopedic surgeon indicating that there was no question that removing the excess skin on the gut would help my back by allowing me to stand straighter, tighten the abdomiinal muscles which ultimately helps the back muscles etc. It wasn't even my ortho surgeon I've worked with for years but someone who was filling in for him while he was on medical leave. The guy was very understanding and supportive and wrote a bang up letter. So like the others said, document everything. BCBS of WI would not have covered mine just because it hung past the pubic area, there had to be a clear medical problem that could be helped or eliminated. I never had any skin problems before or after WL so my only hope was the back. For the first time in my life I was glad to have back problems. I do have to admit that losing 252 lbs and having all the excess cut off has pretty much eliminated the back symptoms I've had for years and had to use epidural steroid injections, anti-inflammatories and physical therapy to keep reasonable. So ultimately having the PS did what it was supposed to do. <p>Good luck and don't give up on the gut. Personally I wouldn't even ask for the arms unless you are having major skin breakdown and rashes/infections. Then make sure you get it thoroughly documented each time it's an issue and then fight hard. In that situation, insurance should cover it because the skin removal will solve a medical problem.
   — zoedogcbr

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