Any Scenario Where Insurance Covers Plastic Surgery?

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Dr. Gupta,

I have an apron from 4 abdominal surgeries on the same area (2csections, an exploratory, and hysterictomy). Under the apron is pretty much numb. Sometimes I get rashes there despite toweling off well etc. I once had the skin ulcerate from the build up of moisture and thought I had the flesh eating virus.

Are there any possible scenarios in which plastic surgery correction could possibly be covered by medical insurance. I ask realizing what one company would consider another would not.

Thank you for your time on this forum. You are a perfect compliment to this journey.

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What are some reasons that may constitue medical necessity to have a tummy tuck, arms, breasts, any type of plastic surgery. I am 99.9% sure that my insurance will not cover any type of surgery, but there is so much excess skin I can't see my female regions (sorry for the visual). I scheduled a consult with a doctor today, but I am curious on your views.

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Hello SocalKelly and WUCRew83

You both ask a very good question. In my experience, insurance does sometimes cover the cost of plastic surgery reconstruction after weight loss, but usually only the abdomen. I have VERY RARELY seen an insurance company cover the arms and thighs, but NEVER the breasts.

To have the best chance of coverage, you will have to document chronic rashes underneath the skin pannus (skin apron) and history of ulceration and infection. The other thing that I have found helpful to document is a history of lower back pain due to the excess weight of the hanging extra skin apron. If you have a hernia in the abdomen after your bariatric surgery, insurance will usually cover repairing that, and the plastic surgeon can sometimes get the skin excision covered at the same time.

When you see your plastic surgeon in consultation, ask them if they would help you in applying for insurance coverage of the reconstructive procedures. Hope that helps, and good luck with your surgery.

Edited by Dr. Abhay Gupta

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