Will insurance pay to remove an apron belly?

Author: Sean Hill III  |  Last update: Thursday, June 26, 2025

If surgery is warranted because excess skin or tissue is causing persistent health issues (such as skin conditions, functional deficit, or interference with every day activities), a panniculectomy may be covered by your insurance plan. A tummy tuck is generally not covered by insurance.

How to get insurance to pay for apron belly removal?

Answer: Panniculectomy Panniculectomy is the term used for removing the ``apron'' or pannus. In order to have any chance of getting an insurance company to cover it, it must be deemed medically necessary, meaning the apron is causing medical problems. Documented skin infections will help.

How much does it cost to remove the apron belly?

The national average cost* of a panniculectomy is $7,000, with a range between $5,393 and $13,618. The overall cost of the procedure can be impacted by the surgeon's experience, amount of skin removed, anesthesia type and clinic location.

How do you qualify for a panniculectomy?

People who have lost a significant amount of weight and who subsequently have excess skin and fat that interferes with their appearance, movement, and comfort are excellent candidates for a panniculectomy. You must also be a non-smoker or be willing to stop if you are and be in good overall health.

What makes a tummy tuck medically necessary?

What makes your tummy tuck medically necessary? (covered by insurance) 5 things.
  • Treatment of back pain
  • Repairing abdominal wall laxity or diastasis recti
  • improving appearance
  • Treating psychological symptoms.

Will insurance pay for a tummy tuck?

What disqualifies you for a tummy tuck?

What other factors might delay my tummy tuck?
  • Preexisting health issues.
  • Currently smoking or using tobacco products.
  • Obese or overweight.
  • Body Mass Index (BMI) over 30.
  • Any previous clotting issues or surgical complications.
  • Currently taking any medications, anticoagulants, or supplements that might interfere.

What would make a panniculectomy medically necessary?

A panniculectomy is considered medically appropriate when there is documentation of a significant functional impairment, such as persistent cellulitis, abscess, or skin ulceration that has been refractory to medical therapy, not recurrent (i.e., does not clear up then recur), for at least six months, including a ...

How long does it take for insurance to approve a panniculectomy?

information from your visit is sent to your insurance company for authorization. This process can take from 14-60 days. medical information, your insurance company will make the decision about whether to cover your panniculectomy.

What doctor approves panniculectomy?

A panniculectomy involves many choices. The first and most important is selecting a board-certified plastic surgeon who is a member of the American Society of Plastic Surgeons (ASPS).

Does a panniculectomy lift the pubic area?

A panniculectomy is surgery to remove excess hanging skin and fat, called a pannus or apron, from the lower belly. It's often done after a big weight loss when the stretched skin may hang over your genitals or extend to your thighs or beyond. Some doctors call it a lower abdomen lift.

How do you prove you need a panniculectomy?

Panniculectomy may be performed for both medically necessary and cosmetic reasons. The medical need for this procedure must be established by documenting that the enrollee has significant symptoms that cannot be adequately managed with more conservative or less invasive measures.

How to get a free tummy tuck surgery?

To increase your chances of getting a tummy tuck covered by insurance, you'll need to meet specific requirements: Medical Necessity – your surgeon must document the medical necessity of the procedure, outlining how the excess skin or abdominal wall laxity negatively impacts your physical health and quality of life.

Is surgery the only way to get rid of an apron belly?

Apron belly may appear as a shorter, smaller amount of sagging skin and fat, or it may be a larger, longer amount that hangs down over your genitals and thighs or even lower. Unless it is very minor, a surgical procedure is necessary to eliminate an apron belly, either a plus size tummy tuck or a panniculectomy.

How do you qualify for panniculectomy insurance?

Panniculectomy surgery may be eligible for coverage when all of the following criteria are met: 1. There is clinical documentation of: A. Extra/excess skin from the lower part of the belly (i.e., panniculus) causing chronic or recurrent skin conditions.

How many sizes do you lose with a panniculectomy?

You can generally expect to lose between two and three pants sizes following abdominoplasty. However, if you have a great deal of excess skin and you combine this procedure with liposuction, you may be able to lose four or more pants sizes.

How long is the hospital stay after a panniculectomy?

Recovery after a panniculectomy begins in the hospital, immediately following surgery. Depending on the amount of tissue removed and personal circumstances, patients may spend one night in the hospital following surgery.

What reasons will insurance cover a tummy tuck?

What reasons will insurance cover a tummy tuck?
  • Muscle Weakness or Hernias: If the abdominal muscles are severely weakened or if there's a hernia, a tummy tuck might be necessary to repair these issues. ...
  • Chronic Pain: Persistent pain due to excess skin or muscle issues can sometimes make a tummy tuck medically necessary.

Does panniculectomy include fupa?

Also known as body contouring surgery, a panniculectomy involves changing the shape and contour of the body by removing excess skin and fat that hangs from the abdomen. Many people may find fat below the bellybutton area, which they may refer to as a FUPA, to be the most difficult type of fat to lose.

Is a panniculectomy a high risk surgery?

Panniculectomy patients are at a high risk for venous thromboembolism for a multitude of reasons, such as long operative times under general anesthesia, large area dissection, and prolonged periods of decreased activity postoperatively.

What does a panniculectomy cost?

How much does panniculectomy cost? In the United States, the cost of excess skin removal surgery ranges from $8,000 to $15,000, covering the surgeon, anesthesia, and facility fees but not post-operative care or medication. Costs vary by location, with major cities typically charging more than rural areas.

What doctor do you see for a panniculectomy?

A panniculectomy should be performed by a board-certified plastic surgeon who has experience in this surgical body contouring procedure. The surgery is usually performed under general anesthesia and may require several hours to complete. You may be required to stay in the hospital following surgery.

What is a grade 5 pannus stomach?

The size of a panniculus varies and can be graded on a scale of 1 to 5, which correlates with how far it extends. Grade 1 reaches the mons pubis, while grade 5 extends to or reaches past the knees.

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