How to Qualify for a tummy tuck using Blue Cross and Blue Shield?

Established in 1929, Blue Cross Blue Shield (BCBS) continues to provide affordable healthcare coverage to its members in America. BCBS has a personalized approach for every state and every community it caters to, where they work collectively with qualified doctors and hospitals.

Wondering if Blue Cross Blue Shield covers tummy tuck in their plans? Check out the article to know more.

How can I get a tummy tuck using Blue Cross and Blue Shield?

How can I get a tummy tuck using Blue Cross and Blue Shield?
When Will Insurance Cover This?Blue Cross and Blue Shield Coverage
Tummy Tuck (Abdominoplasty)Not Covered (Unless medically necessary)
Panniculectomy (Removal of Panniculus)Covered
Excess Hanging Skin as a Medical NecessityCovered
Cosmetic SurgeryNot Covered
Medically Necessary ServicesCovered
Skin Irritation and InfectionsCovered

Blue Cross and Blue Shield do not cover tummy tuck, or abdominoplasty, under its health insurance plan because these surgeries are considered cosmetic and not medically necessary services. A tummy tuck is indeed a cosmetic surgery that involves the removal of excess skin and fat from the pubis to the umbilicus. The cosmetic procedure might also include tightening of the rectus muscle and creation or disposition of the umbilicus.

However, in certain circumstances, the excess hanging skin can cause a disruption in the daily lives of the patient, and treating it becomes a medical necessity. This condition is called panniculectomy, which refers to the removal of the panniculus, skin hanging from the front of the abdomen. This hanging skin often leads to skin irritation and infections due to constant skin-to-skin contact and lack of hygiene. Since abdominoplasty is a medical necessity, it gets covered by Blue Cross and Blue Shield.

Criteria

Check out the below-mentioned criteria in order to get tummy tuck covered by Blue Cross and Blue Shield:

Criteria For Tummy Tuck Under Blue Cross and Blue Shield
The pannus hangs till the level of the pubic symphysis.
The pannus leads to persistent dermatitis, cellulitis, or skin ulcers that don’t go away after at least three months of non-surgical treatment (such as antibiotics, antifungals, excellent hygiene, or dressing changes).
The panniculectomy is supposed to improve functional impairment. Complete or partial loss of a body part’s functionality is referred to as functional impairment.
If a person has not undergone bariatric surgery, they must have kept their weight steady for at least six months.
A panniculectomy should not be done on a person who underwent bariatric surgery and lost a large amount of weight until at least 18 months following the procedure and only if the patient’s weight has stabilized for the past six months.

Documents required for abdominoplasty by Blue Cross and Blue Shield

  • Medicating records stating treatment was or will be used to treat deformities brought on by trauma, accident, or prior therapeutic process. Without this evidence, the surgery or procedure must be taken into consideration.
  • Proofs of consultations
  • Set of photographs
  • Operative reports
  • Other relevant information

Conclusion

We hope that this article helped our readers in choosing a suitable health insurance plan for the tummy tuck they are planning to get in the near future. Do not forget to read all terms and conditions along with checking if there is any requirement for out-of-pocket payment during the procedure. Stay connected with us for more such informational content.

Also, check out: Will insurance cover tummy tuck for back pain?

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