You may have heard about a panniculectomy, the removal of a pouch or “apron” that causes pain during bowel movements.
If you are overweight, it may be causing you pain and anxiety.
Your physician may have recommended this operation in order to take pressure off the abdominal area and alleviate your discomfort.
Many patients find that they experience some relief from their pain and other patients may be experiencing life-threatening side effects because of their operation.
If you think this operation may help you, but you’re still not sure whether it will be covered by your insurance, here’s what you need to know.
Panniculectomy Covered By Insurance – Why is it Covered?
Most insurance companies do not cover elective skin removal and/or excess skin reduction because these services are elective or cosmetic.
Panniculectomy, on the other hand, is often medically necessary as a means of addressing medical problems or complications.
It is also frequently covered by insurance if the procedure is performed by a board-certified plastic surgeon.
It is important for patients to realize that just because a panniculectomy is covered by insurance doesn’t mean that the doctor performing the procedure will be inexpensive.
In fact, most cosmetic plastic surgery procedures are extremely expensive.
Patients should be prepared to pay up to several thousand dollars for this procedure.
So, why is Panniculectomy covered by insurance?
The reason is that insurance companies want to provide coverage for all patients, regardless of their ability to pay upfront.
As a result, the insurance company often requests that a panniculectomy be performed in order to obtain coverage.
The doctor obtains payment upfront from the patient’s insurance carrier to cover the cost of the procedure.
It is very unlikely that a patient would be able to pay cash for such a procedure.
The second reason is that cosmetic procedures are considered elective procedures.
Thus, insurance companies view them as medically necessary only when they are performed by a licensed cosmetic surgeon.
Furthermore, many insurance carriers view panniculectomy as being covered under the insurance plan only if the procedure is performed by a board-certified plastic surgeon.
Again, it is very likely that such a procedure would be deemed medically necessary by any insurance carrier.
As a result, it is considered by insurers as a necessary treatment.
Because panniculectomy surgery is considered to be medically necessary, it can be more expensive than other plastic surgery options.
Since there are a number of factors that go into determining your insurance company’s payment policy, you should spend some time searching out which plans will let you pay for the procedure in full.
In many instances, insurance companies offer discounts for such procedures as well.
For example, if your doctor has worked with a plastic surgeon who has previously successfully performed the procedure, then you may have a better chance of getting full coverage than if your physician has never done it before.
Panniculectomy Insurance Criteria – How do you qualify for Panniculectomy?
The goal of panniculectomy surgery is to eliminate excess hanging skin and fat in the lower abdominal area to create a firmer, more toned abdominal area.
A panniculectomy is different from an abdominoplasty in that the abdominoplasty usually tightens the abdominal muscles during a panniculectomy.
The lower half of the abdomen is left relatively unadorned.
Patients who have had a previous surgical procedure of a similar type to this one often choose to have this done again in order to remedy the postoperative saggy skin.
A tummy tuck or a reduction may be appropriate for patients whose skin does not excessively sag after weight loss.
It is also performed on patients who have been advised to undergo a reconstructive operation to fix the original defect.
Panniculectomy surgeries have become increasingly popular in recent years because it produces aesthetically appealing results.
When a person loses large amounts of weight, her skin usually becomes saggy and loose, which can produce a negative body image.
In addition, excess abdominal fat may interfere with breathing.
This is especially common among women who have unusually large waists or large hips.
For these patients, the removal of excess panniculectomy tissue allows easier passage of air and better body image.
This procedure may also be helpful in sculpting the abdominal wall to produce a more desirable shape.
There are several considerations that must be addressed before a patient decides whether or not she is a good candidate for a panniculectomy.
The most important factor is the patient’s current weight.
While some surgeons believe that a candidate for a panniculectomy should be in perfect physical condition, others prefer a candidate who is slightly overweight to reduce the risk of complications.
If a candidate’s weight is stable, she may be a good candidate for this procedure.
Additionally, if a person has a large waistline or large hips, she may also benefit from this procedure.
These patients should also be in good cardiovascular and/or neuromuscular health and in generally good health before considering this operation.
A patient that is a loose belly in a large amount is also qualified.
Also, a patient that has hygiene issues due to the excess skin hanging below the pubic region is also a good candidate.
Ulcer patient with recurrent infection from the hanging skin is qualified.
If you recently have gastric bypass or undergo bariatric surgery for weight loss you are also qualified.
In addition, the duration of a patient’s obesity and the type of obesity (i.e. central versus peripheral) play an important role in determining whether or not she is a good candidate for a panniculectomy.
If a person has experienced massive weight loss, she may be a good candidate.
However, a patient who is a smoker is not considered a good candidate for this surgery.
Specifically, a patient who has suffered significant weight loss with hanging skin below the pubic area is considered a good candidate for this procedure.
If a woman’s level of obesity is high and the appearance of her tummy becomes a concern then she’s qualified.
Before deciding whether or not you are a good candidate for this surgery, you should first consult with a cosmetic surgeon to determine your individualized surgical plan.
In addition to your consultation, you should also discuss your expectations regarding long-term success rates/
And whether or not you would prefer to have skin removal surgery performed alongside your tummy tuck.
Be sure to discuss these issues with your surgeon before you agree to undergo this procedure.
Your surgeon will be best able to guide you on whether this surgery is right for you.
If you are a candidate for this procedure, you should be aware that your surgeon will likely make recommendations to reduce your risk of complications after your operation.
Specifically, your surgeon may suggest a revision to fix any medical conditions that were corrected during the initial procedure.
These conditions may include excessive subcutaneous fat, excessive skin loss, delayed wound healing, abnormal bleeding, or excessive scarring.
If these conditions are identified at the time of your initial surgery, they should be corrected during or immediately following your panniculectomy surgery.
While these complications are uncommon, they can still happen, so you should always be informed about any medical conditions that you may have prior to having your body contouring procedure performed.
How do I get my insurance to cover a Panniculectomy?
The first thing to understand is that this surgery, performed by a cosmetic surgeon, has become more widely available in recent years.
In fact, your insurance company will probably be happy to insure you for it.
Most insurance companies have created “group plans” which include such procedures.
If you are in such a plan, you may need to ask your insurance company specifically about it.
You will also need to explain why you want such a procedure.
Your cosmetic surgeon may suggest you get a panniculectomy to take out excess hanging skin and fat.
How do I get my insurance to cover a panniculectomy surgery?
There are some policies that can be purchased to help those in need with the cost of a panniculectomy.
Some insurance companies have agreements with hospitals that allow them to offer payment plans to patients who are considered medically needy.
While it can take a few months to get the money together, it is important for patients to look into the policy options with their insurance company.
If the hospital won’t cover the operation, then the patient may be able to arrange for money to be sent to him or her instead of having the procedure paid for by the insurance plan.
In most states, you have the option to have panniculectomy surgery paid for through insurance.
Many plans offer coverage for the procedure.
This is something to look into when you are in the market for cosmetic surgery.
If you already have health insurance, you should ask about payments plans that will allow you to have the surgery paid for in a convenient manner.
Sometimes your doctor will work with you to come up with a payment plan.
Another option that you may want to look into is having your insurance covered by a private insurance company.
The benefit to this is that you will get a better price for the procedure.
Just because your insurance company does not cover surgeries like this does not mean that you cannot pay for it in other ways.
You should consider talking to your insurance provider and finding out what they will not cover.
Another option is to work with a charity that provides a program where people who are facing surgery can ask for assistance.
Sometimes these charity programs will help pay for some or all of the cost of the operation.
And sometimes, the only thing the patient needs to do is to ask the charity to cover the rest.
The charity will work with the insurance company to find out what kind of coverage is available and will help the patient put together a financial plan.
This process might require a little bit of work on the part of the patient or family, but it might be worth it if they qualify for free or reduced-cost care.
Those who can’t afford to pay for their own surgery may find that this is a better option, especially when they consider the alternative.
As long as your cosmetic surgeon is board-certified and he tells you that the procedure is necessary, then he can explain all of your options.
He should be willing to tell you what your options are if you are willing to discuss them.
No matter what kind of coverage you’re looking for, chances are good that you’ll be able to find something that will suit you.
It’s important to remember that your insurance company has its own set of rules for which surgeries are considered eligible.
So it’s important that you find out how you can qualify for free or reduced-cost care in your particular state.
Once you know how you can get your insurance to cover a panniculectomy, it should be easier to make sure that you have the surgery that will improve your quality of life.
Panniculectomy Cost With Insurance – Here’s what you need to know and Expect!
Panniculectomy surgery cost ranges from $8,000 to $16,000 depending on the surgeon.
These costs include anesthesia and any other extra procedure that might be involved.
When you are considering panniculectomy surgery, it is important to know and understand what the procedure entails as well as what the potential costs may not be.
While many insurance companies will cover at least some of the cost, there are others that may not.
Because of this fact, it can make a significant difference whether you choose to have this procedure performed by an independent physician or if you try to tackle the task on your own.
For those that feel that consulting with a physician is too dangerous or do not trust the knowledge that comes with a doctor, there are plenty of resources available online to help guide in making this decision.
One thing to consider when analyzing the cost of the procedure is just exactly what it is.
Essentially, the operation is considered surgical, and because of its potential to alter the anatomy in some way, the cost can be deemed high.
It is vital that any insurance companies that you contact understand this, and ask you questions about why you would have this done.
From there, they will be able to provide you with the cost – either flat out, or in more detail, such as the potential for additional surgeries, and additional supplies that you may not need.
Often, these companies will not charge extra for such items but will rather make a larger contribution towards their bottom line by passing on the cost.
As such, it is in your best interest to ask any questions that you have and find out just what the cost will end up being before you agree to the contract.
Additionally, it is often noted that most insurance companies require that you have one or more subsequent surgeries performed regardless of the initial operation.
These types of stipulations usually relate to the fact that the subsequent surgeries must come close enough in time to the first to create a change in your appearance.
This change is typically referred to as a ‘substance adjustment’.
For this reason, it is extremely important that you thoroughly discuss the potential cost changes with your physician.
And always include any additional surgeries that may need to be performed in the event that you are unable to successfully correct the initial procedure.
In addition to the potential costs associated with the procedure itself, many insurance companies will also seek to recoup the cost from you for additional surgeries.
Many times, this will involve creating a larger incision, which requires additional recovery time.
In addition, additional surgeries may also be required if the original surgery itself was botched.
Because of the potential for additional surgery, and the fact that it is nearly impossible to predict how long any particular surgery may take.
It is typically suggested that you do not schedule additional surgeries until you have completed the initial procedure.
This will ensure that you are not in need of another major surgical procedure at a crucial time.
It is important to note that sometimes, panniculectomy surgery cost is considered excessive by your insurance company.
In these instances, you may need to speak to a representative from your provider to determine if there are other options available to you that will better meet your healthcare needs.
If there are, you may be able to bring that information back to your doctor and receive a revision to the initial procedure that is recommended.
In many instances, your physician will be able to reschedule the procedure without additional costs coming up.
The results of a panniculectomy surgery can be quite amazing, but they must be monitored and cared for properly in order to prevent complications such as infection.
If you were injured as a result of the procedure, you may be entitled to compensation for lost wages.
You may also be eligible for rehabilitation assistance, which can help to alleviate some of the medical bills you have incurred while recovering from your injury.
Talking to your insurance company about ways to pay for the operation is always a good idea.
While it may not be covered by your plan, you may be surprised at just how much your health plan will cover up to this point in time.
Being able to save money on your panniculectomy surgery cost with insurance can make all the difference in the world to your pocketbook.
Does Medicaid Cover Panniculectomy – (Will Medicaid Pay For A Panniculectomy)
Medicare will only cover the cost of an abdominal panniculectomy if the physician who performs the procedure decides that it is medically necessary.
The reason this is true is that an abdominal panniculectomy is performed for a completely different reason.
It is performed to remove a stomach pouch that is obstructing a major bowel function.
So although the procedure may be covered by Medicare Part B, it is not necessary.
Medicare will cover a portion of the cost of an abdominal panniculectomy if the physician also offers Medicare Part D prescription drugs.
This is important to remember because many patients have been turned down for an abdominal panniculectomy due to their inability to take the medication.
A great deal of frustration occurs when a patient is turned down for a medical procedure that is necessary but cannot afford to pay for it.
If your physician has both Medicare Part A and Medicare Part D then you may be entitled to a more reduced rate.
Many times patients can obtain additional discounts through their primary care physician if they also add them to their current plan.
For most individuals, a panniculectomy is covered by Medicare regardless of its type.
These procedures are generally covered only if they are performed by a certified specialist.
Because abdominal panniculectomy surgery is often covered by Medicare even with a small surgical deductible, it is often used to save money.
If the procedure is performed by a panniculectomy specialist, then there may be other charges (for example, the cost of medications, tests, and post-operative care) that Medicare does not cover.
Although many Medicare policies will specify that the procedure must be performed by a physician, in some cases this is not always the case.
You should be aware of these things when negotiating a payment plan.
As a result, you may have to pay more out of pocket than you would if your procedure was performed by a specialist.
Not all procedures are covered by Medicaid, including one common plastic surgery procedure called a tummy tuck.
The reason is that the United States government only offers a limited amount of funding for this surgery.
For each procedure that is covered, it is typically limited to a maximum of only thirty percent of the overall cost.
So, because it is such a popular procedure, surgeons try to do as many surgeries as possible to make their charges as low as possible.
Unfortunately, this often means that they perform surgeries for less than they should, and as a result, they do not receive the reimbursement that they deserve.
Does United Healthcare Cover Panniculectomy?
Body Contouring and Panniculectomy procedures are covered by United Healthcare.
A very common procedure that is often covered is a panniculectomy.
Many people choose this procedure when they have a large tummy tuck scarring.
Does United Healthcare cover this particular procedure? Yes, it does.
Many women have this done to remove the extra fat that does not come out of the tummy during the pregnancy.
This is also sometimes done for cosmetic reasons.
Your surgeon will explain the different ways to go about having this surgical procedure.
United Healthcare policies cover elective surgery as long as the surgeon is experienced and is a board-certified plastic surgeon.
In most cases, a surgeon will need to complete written documentation stating why the procedure is necessary, how it will be performed and who will oversee its success.
Once you get the approval from your surgeon, you need to go to your United Healthcare.
Find out what is covered and what is not.
If you are having the procedure because of your medical condition it might be covered under United Healthcare. Other times it is not.
If a patient has had previous surgeries or is undergoing other medical procedures that leave them at risk for bleeding or infection, panniculectomy may not be covered by health insurance.
Health insurance plans may cover a portion of the procedure or may require a patient to obtain pre-certification, prior to undergoing the procedure.
Patients should consult with their primary care physician to determine if they qualify for pre-certification.
It is important to remember that panniculectomy is a major surgical procedure and is typically covered only if the procedure is performed by an experienced and qualified surgeon.
Is this a permanent procedure?
In most cases is not a permanent procedure but will most likely be covered by United Healthcare if it is deemed medically necessary.
Insurance companies will usually not cover cosmetic procedures unless it is reconstructive.
Not every insurance company does this though.
There are several that do have restrictions or no restrictions at all on this particular procedure.
Some of the criteria that will be met are proof that the patient has intractable rashes that have been treated with IV antibiotics for at least a year.
Likewise, the weight loss must be at least over 100 lbs.
Also, panniculectomy coverage will only be considered when panniculus hang at the pubis and is medically needed to be removed.
And when documentation is presented that the panniculus is the original cause of skin conditions.
The functional impairment must be proof that it is due to the panniculus.
This procedure, which involves the removal of a small pouch, must demonstrate good results in helping the patients to achieve their weight-loss goals.
Some insurers are very restrictive about having a Pannicuation Deductible.
This is a deductible that you must pay before being covered by your insurance company.
And this deductible can differ greatly between different companies and can also depend on the type of procedure that you have.
You must read all of your policy paperwork to find out exactly what is covered.
After you have been approved for panniculectomy you will be told what type of Medication will be prescribed to you to take before and after the procedure.
There will also be certain things that you should avoid after you have been discharged from the hospital.
You may not drive or operate any type of mechanical device or equipment.
If you have any allergies or diseases that will interfere with the procedure, it would be advised to notify your insurance company in advance.
Also, if you have ever had your appendix removed or adhered to your stomach it may be covered by your health insurance policy.
This is mainly due to the fact that the procedure will eliminate the need for the appendix to be removed. It will just be absorbed by your body.
It is possible that you will not be able to obtain coverage for this procedure if you have a health condition that prohibits the completion of this surgery.
Also, it is important to note that this procedure is usually covered by your preferred insurance provider.
Before deciding on the procedure, you should do your research and speak with your insurance provider to see if they are comfortable with this procedure.
It is also important, to be honest with your surgeon when discussing the details of your procedure so that they can provide you with the correct information and the best recommendations.
Does Blue Cross Blue Shield Cover Panniculectomy?
The Blue Cross has become a well-known health insurance provider in many countries around the world.
The fact that they provide coverage for panniculectomy surgery is one of their many great benefits to their patients.
With this being said, patients often wonder does the Blue Cross Blue Shield covers panniculectomy surgery.
The answer to that question is yes, but they will not cover it under any special circumstances.
When a person does undergo a panniculectomy surgery, it can be either elective or reconstructive.
The elective is when the person has the surgery for medical reasons.
This can be due to the fact that the tumor or disease has caused other organs in the body to malfunction.
For example, in some instances, a woman after giving birth now has big pannus which causes cellulitis, and has failed to heal for at least 3 months of non-surgical treatment.
In these cases, a panniculectomy surgery would be performed to try and improve the quality of life for the child.
The next category that falls under health insurance, which is covered by Blue Cross, is reconstruction surgery.
The reason that this is covered by Blue Cross is that it is usually a reconstructive surgery that will be used to help a patient look better after a certain surgery has been performed.
For example, if someone has suffered burns from a fire or had some type of traumatic accident, reconstructive surgery could be performed to correct the problem.
The last thing that you want to know about does blue cross cover Panniculectomy surgery is that they only cover the actual hospital costs related to the procedure itself.
If you are an inpatient, then the costs associated with that stay will be covered.
However, you will need to make arrangements to pay for your own lodging in the event that you have to stay overnight.
If you were using a health care insurance plan to pay for the hospital expenses, then it is likely that those costs will also be covered.
In most cases, a Panniculectomy is covered as general surgery.
However, there may be specific procedures that are considered elective that are not covered.
In some cases, if there is a history of mental illness in either the patient or the family, then it may be considered elective surgery.
This means that it will not be covered by your insurance unless there is proof of mental illness and the physician certifies that the patient needs the procedure.
When it comes down to it, all insurance plans do not cover Panniculectomy Surgery.
Your best bet in getting coverage is to go online to the Blue Cross website and find out what is or isn’t covered.
You will need to complete a short form prior to submitting your insurance request.
They will ask for contact information such as name, address, phone number, and insurance provider.
After you fill out the form and submit it, you can then get back to the site and let them know what your coverage options are and how much you are willing to pay out-of-pocket.
How Long Is The Hospital Stay After A Panniculectomy?
After the surgery, you may need to stay for about 2-3 days in the hospital.
You may stay longer if there is any complication or need for further observation.
Normally you will be asked to walk by taking a few steps once you have recovered from anesthesia.
You will observe some pain and swelling but you don’t need to worry about it as it will go down as the healing takes place.
Likewise, pain killer drugs will be administered by your doctor to make it subside.
Also, bruising, numbness, and tiredness will be experienced but don’t worry as it will reduce day after day.
The next day after your surgery, a girdle (something like elastic) will be given to you to wear by your doctor as extra support as you heal.
And for the next 4 to 7 weeks you must abstain from strenuous activity or anything that will make you strain.
All things being equal after 4 weeks you should be able to go back to work.
Although the swelling will take about 3 months to go down as the wound heals.
But, it will take about 2years to see your final results and the scars will fade out as well.
When you first decide to undergo a surgical procedure such as a Panniculectomy, your doctor may give you an estimate of how long you will need to stay in the hospital.
You will need to discuss this number with him before you proceed with the surgery.
The best time to ask this question of your doctor is when you are getting ready to have the procedure done.
This way you can get the answers you need without having to worry about how long you are going to be gone.
In fact, you may even want to ask this question at the time of your consultation.
Most physicians will be more than happy to tell you the length of time you should expect to be out of work.
However, some physicians may try to get you to agree to go through the procedure without telling you the answer.
One reason why physicians recommend answering the question “How long is the hospital stay after a Panniculectomy?”
Before undergoing the procedure is so that you have a better understanding of what is involved during surgery.
Many people who have gone under the knife have ended up with more health problems than they had before they went under the knife.
It is often necessary for a physician to perform additional tests and scans to determine why you had such a reaction prior to the procedure.
Sometimes, it actually depends on your age and general health.
If you are young and healthy and are at light exercise on a regular basis, then you may not have any problems related to this procedure.
On the other hand, if you are older or if you are exercising less than your normal schedule, you may find yourself asking this question of your doctor.
So, you should take into consideration your own health conditions, your feelings about the procedure, and the overall procedure itself.
If you are young and in good health, then the hospital stay should not be more than a few days.
Also, if you have special health concerns or are older, or if you are injured, you may find yourself being out of commission for several days or a week or more.
In terms of a panniculectomy being a medically acceptable procedure, it is not considered cosmetic only if done for reconstructive reasons.
Lipectomy is considered cosmetic only if done for cosmetic reasons.
However, some lumpectomies are done for reconstructive purposes to help relieve pain or to improve mobility of the body part affected, such as the knees and hips.
Sometimes, surgeons perform both procedures simultaneously.
Your doctor should be able to explain this to you.
If you are considering this surgery because you are unhappy with the appearance of excess skin or excess fat around the abdomen, you may be pleased to learn that a panniculectomy will remove only the excess skin.
This results in a firmer, flatter look for the midsection that stays put no matter what weight you lose.
In addition, the results of the surgery can be more closely monitored, which can make it safer and more effective as an end result.