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Getting it covered

Article-Getting it covered

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  • 10 tips to help MWL cosmetic patients navigate what their insurance may cover

Insurance providers typically cover only post-bariatric abdominal panniculectomies, if they cover any post-bariatric procedures at all. Therefore, consider these 10 tips to help MWL cosmetic patients navigate — and maximize — what their insurance policies may cover.

  • Check to ensure a patient's policy does not specifically exclude MWL-related surgeries
  • Ensure the patient's pannus hangs below his or her pubic bone onto the mid-thigh or between the thighs, causing difficulty in ambulation
  • Obtain a documented history by a patient's primary care doctor of related problem history (e.g., chronic active panniculitis)
  • Ensure the history of chronic active panniculitis documents that symptoms have persisted for at least three to six months
  • Document chronic irritation and hygiene problems caused by overhanging skin in a letter accompanied by photographs for the insurance company
  • Know the separate CPT code for infraumbilical panniculectomy: 15830
  • If appropriate, combine a panniculectomy with certain open abdominal surgeries. Insurers seem more willing to cover the procedure if you're fixing a hernia simultaneously, for example (although this is not the case with hysterectomies)
  • Consider operating in the tenth to twelfth month following bariatric surgery when patients still have some excess weight in order to meet insurers' criteria (although this could affect their wound healing ability and create other problems)
  • Combine insurance-covered procedures with out-of-pocket procedures; in these cases, insurance companies tend to cover some important parts of the costs
  • Don't promise patients you're going to get anything covered. Patients also need to understand that there is a cosmetic fee usually associated with post-bariatric procedures to obtain optimum results

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