Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb;145(2):545-554.
doi: 10.1097/PRS.0000000000006513.

Review of Insurance Coverage for Abdominal Contouring Procedures in the Postbariatric Population

Ledibabari M Ngaage  1 , Adekunle Elegbede  1 , Lauren Pace  1 , Carly Rosen  1 , Sami Tannouri  1 , Erin M Rada  1 , Mark D Kligman  1 , Yvonne M Rasko  1
Affiliations

Review of Insurance Coverage for Abdominal Contouring Procedures in the Postbariatric Population

Ledibabari M Ngaage et al. Plast Reconstr Surg. 2020 Feb.

Abstract

Background: Following bariatric surgery, patients develop problems related to lax abdominal skin that may be addressed by contouring procedures. Third-party insurers have subjective requirements for coverage of these procedures that can limit patient access. The authors sought to determine how well third-party payers cover abdominal contouring procedures in this population.

Methods: The authors conducted a cross-sectional analysis of insurance policies for coverage of panniculectomy, lower back excision, and circumferential lipectomy. Abdominoplasty was evaluated as an alternative to panniculectomy. Insurance companies were selected based on their market share and state enrolment. A list of medical necessity criteria was abstracted from the policies that offered coverage.

Results: Of the 55 companies evaluated, 98 percent had a policy that covered panniculectomy versus 36 percent who would cover lower back excision (p < 0.0001), and one-third provided coverage for circumferential lipectomy. Of the insurers who covered panniculectomy, only 30 percent would also cover abdominoplasty. Documentation of secondary skin conditions was the most prevalent criterion in panniculectomy policies (100 percent), whereas impaired function and secondary skin conditions were most common for coverage of lower back excision (73 percent and 73 percent, respectively). Frequency of criteria for panniculectomy versus lower back excision differed most notably for (1) secondary skin conditions (100 percent versus 73 percent; p = 0.0030), (2) weight loss (45 percent versus 7 percent; p = 0.0106), and (3) duration of weight stability (82 percent versus 53 percent; p = 0.0415).

Conclusions: For the postbariatric population, panniculectomy was covered more often and had more standardized criteria than lower back excision or circumferential lipectomy. However, all have vast intracompany and interpolicy variations in coverage criteria that may reduce access to procedures, even among patients with established indications.

PubMed Disclaimer

References

    1. Kitzinger HB, Abayev S, Pittermann A, et al. The prevalence of body contouring surgery after gastric bypass surgery. Obes Surg. 2012;22:8–12.
    1. American Society of Plastic Surgeons. Practice parameter for surgical treatment of skin redundancy for obese and massive weight loss patients. Available at: https://www.plasticsurgery.org/documents/Health-Policy/Guidelines/guidel.... Accessed January 14, 2019.
    1. Mitchell JE, Crosby RD, Ertelt TW, et al. The desire for body contouring surgery after bariatric surgery. Obes Surg. 2008;18:1308–1312.
    1. Steffen KJ, Sarwer DB, Thompson JK, Mueller A, Baker AW, Mitchell JE. Predictors of satisfaction with excess skin and desire for body contouring after bariatric surgery. Surg Obes Relat Dis. 2012;8:92–97.
    1. Migliori F, Rosati C, D’Alessandro G, Cervetti GG. Body contouring after biliopancreatic diversion. Obes Surg. 2006;16:1638–1644.

MeSH terms