Will insurance pay for a tummy tuck after major back surgery, fused spine and back pain caused by a large abdomen?

Q:

I have lost over 100 pounds over the last several years.  Between that and giving birth, I have a huge blob for a belly. I know insurance will pay for a full tummy tuck under certain circumstances.  Three years ago I had to have major back surgery,  I am fused from L3-S1 and I have two rods and six screws in my back. I want to know if this will give substantial reason for my insurance to pay.  The weight of my stomach is constantly pulling against the forces of my fusion, causing me terrible back pain.  Thank you for your advice.

A:

Insurance will never pay for a tummy tuck. They will occasionally pay for a panniculectomy, or removal of excess fat roll that is causing repeated ulcerations and infection. I have, however, had problems with them paying even for that. It would be exceptionally rare for them to pay because of back pain. An abdominoplasty or tummy tuck entails also moving the belly button and using the extra upper abdominal skin to cover the entire abdomen. It is a cosmetic procedure, whereas the panniculectomy is reconstructive and merely removes the excess lower abdominal skin (and, occasionally, the belly button if it has stretched enough to be below the pubis).

R.T. Buchanan, MD

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