In today’s day and age of turbulence in the healthcare industry, it’s crucial to understand what is and isn’t covered by your insurance providers. One thing that is very rarely covered by most major healthcare providers is cosmetic surgery- medical procedures that serve few medical benefits, and aren’t necessary for the health of the patient. That isn’t to say that there aren’t instances in which medical insurance will provide funding for such a procedure- for instance, in the case of reconstructive surgery- but most cosmetic procedures will be eschewed by major medical insurance providers.
One such procedure, which is a cosmetic surgery that isn’t reconstructive or medically necessary, is the tummy tuck procedure, in which liposuction techniques are used to reduce fat from the abdomen, diaphragm, and pelvis. It’s used primarily for cosmetic purposes- that is to say, reducing a person’s visible fat. It doesn’t act as a cure for obesity, it doesn’t remove stretch marks, and it doesn’t have any real health benefits for the average person beyond removing some non-essential fat. As a result, it isn’t covered by most medical insurance providers.
Now, that isn’t to say that there aren’t some instances in which a tummy tuck can be covered by an insurance provider. There are a few circumstances in which an insurance provider would pay for a Tummy Tuck procedure, despite its status as cosmetic surgery.
Tummy Tucks can serve a beneficial medical purpose, but only exceptional circumstances. One of the most common reasons for a medically necessary tummy tuck is from postpartum medical complications in a new mother. For someone who has recently given birth, there are a number of serious issues that can arrive with your anatomy due to extreme changes in a short time. Some of these issues- including urinary incontinence and back pain- can be resolved with a Tummy Tuck procedure. Tummy Tucks can also repair muscular damage to the abdomen, and resolve other medical issues involving the stomach region of the human body.
Studies have also revealed the use of Tummy Tucks in aiding patients who have severe back pain can be hugely beneficial and have already been used in medical practice to relieve cervical and thoracic back pain. If you have chronic back pain, you may be able to receive clearance from your doctor for a medically sanctioned tummy tuck, at which point most major insurance providers would concede it is medically necessary, and fund the procedure.
Tummy Tucks can also be used to relieve a herniated intestinal loop, in the case of such an occurrence. A hernia is when an internal organ or tissue bulges out through an abnormal hole in the lining of the muscle, resulting in severe abdominal pain. Because it can sometimes take months- or even years- to resolve itself through the natural healing processes of the body, many medical professionals determine it an extreme medical issue and can treat it with abdominoplasty (or a Tummy Tuck) procedure. This would be covered by most major medical insurance providers.
In the long term, getting your insurance to pay for your medical procedures isn’t an easy thing, and going to extreme lengths for it is a form of insurance fraud, which, under federal law, can be anything from a Class A Misdemeanor to a Class E felony, and result in severe legal penalties. Don’t fake a medical emergency in order to get your insurance to pay for it. In addition, you should be communicative and responsive to the advice of your primary care physician, and your health insurance provider.
Dealing with an insurance company can be a mess of red tape and paperwork, and sometimes people can be easily frustrated with the process, making it difficult for them to remember that their insurance provider is not the bad guy. Always be open and attentive to the advice of your insurance provider, as they really do have your best interests at heart and want to see you happy and healthy.
Whenever you’re trying to handle a medical issue or procedure, your best source for information, advice, and a path forward will be your primary care physician. Their job is to ensure that you’re in the healthiest state possible, and they don’t want to see you hurt- or in jail for insurance fraud. If you think you qualify for medical coverage for your abdominal medical complication, talk to your primary care physician.
As mentioned earlier, insurance fraud is a really serious crime and can be punishable by up to 5 years in state prison, and a $50,000 fine- far more expensive than simply paying for the procedure out of pocket initially. And I hear prison food isn’t great for keeping yourself thin. In short, faking a health problem for the sake of a wholly cosmetic procedure is short-sighted and unethical in the extreme.
The fact of the matter is that insurance companies, while they do want the best for you, have to protect themselves just as much as you. As a result, trying to get the insurance companies to pay for something that simply isn’t medically necessary is going to be extremely difficult- and usually unnecessary grief for everyone involved, including yourself. Sometimes, it’s simply better to pay out of pocket for this kind of thing.
Paying out of pocket is usually the safest option, legally speaking, and for a medical procedure, the cost isn’t so prohibitive that the average person couldn’t afford it without saving up a little bit of money here and there for a while. Paying for abdominoplasty out of pocket means you’re not risking accidentally defrauding your insurance company, and you can feel comfortable with your financial decision knowing you covered it yourself.
The average cost of a Tummy Tuck varies depending on whoever you’re receiving the treatment from, but the minimum end of the scale usually evens out at around $4,000, and the higher cost of the treatment tends to be around $18,000. Of course, this sounds incredibly expensive, but a dollar here and a dollar there from every paycheck can afford you the money you need if you’re a member of America’s substantial middle class.
Luckily for those who can’t necessarily afford the higher prices necessary for a tummy tuck, there are payment plans available. If you require financial aid in getting the medical or cosmetic treatment you require, and your insurance company can’t provide you with the funds you require or else refuses to cover you, then speak with both your primary care physician and the clinic which you receive the procedure from- most offer payment plans to make it more affordable.
At the end of the day, you really can’t put a dollar sign on your health and happiness. That’s, ultimately, what liposuction offers you- confidence in yourself and a happier, healthier perspective on yourself and your body. Tummy tucks may not be medically necessary, per se, but there are many who would argue that they are emotionally necessary. Don’t let the price point be the inhibitor to the version of yourself you want to become.
Contact us today to schedule your appointment with the renowned plastic surgeon and breast & body specialist Dr. Mark Schusterman. Take your first steps to a more beautiful you.
1200 Binz St Suite 1198, Houston, TX 77004