Insurance coverage criteria for panniculectomy and redundant skin surgery after bariatric surgery: why and when to discuss

Abstract

A dramatic increase in bariatric surgery has increased the number of patients with redundant skin/large panniculus after massive weight loss. This is best treated by surgery; however, not all patients with redundant skin/panniculus get authorization from insurance providers. There are certain insurance coverage criteria for panniculectomy that need to be met by patients for approval. Our search also demonstrated that there are not established criteria/guidelines for different body parts such as inner arms and thighs other than the pannus amongst third-party payers. These cases are appraised individually by third-party payers based on presented signs and symptoms. It is of utmost importance that members of a bariatric team are knowledgeable on these guidelines and should be able to discuss if necessary; however, currently utilized criteria should be discussed with patients, preferably in pre-bariatric surgery phase, and ideally by a plastic surgeon. Advantages are several-fold and discussed in the article.