Should insurance ever cover a tummy tuck?

On the BIG Medicine show I was up way too late last night watching, there was this woman that lost 200 pounds.  She had the worst hanging skin I've ever seen.  Seriously, her upper arms hung down to her waist while her arms were stretched out straight and the skin on the end was all red and bumpy and gross.  Her belly hung down to her knees and her back was just sections of hanging skin.  She might have had an ulcer, but the doctor couldn't tell because of all the skin.  She got rashes in the folds and bathing was a huge process.  All because she LOST all that weight.  They taped segments of her working out and she was wearing a normal short sleeved tee shirt and her arms were just these giant dog jowls hanging out of her sleeves.

Her doctor submitted his opinion or advice or diagnosis or whatever to the insurrance saying that she needed to have that skin removed or it was dangerous.  Her insurrance denied the claim (duh) saying it was cosmetic surgery.  Period.    I have a few thoughts on this.  A) they are going to have to start dealing with the massively obese people that lose weight and have this problem because it is happening more often and B) if a doctor states that this is medically needed, and just based on common sense it clearly is in this case, they REALLY should cover that.  However, I also think that she is insane for not covering it herself after the insurrance company said no.  She was a well dressed person with a decent car and an OK house.  Whatever her income level, it seems to me that if she could afford a car, she could probably afford a $15,000 loan to fix that.  Even maybe less if she just wanted to fix some of the issue.  There are medical loans that she could get and the doctor was willing to do it pro bono (is that just a lawyer term?)  But no, that was the end of it.  The insurrance company said no and she just cried and went home.  I'm hoping that maybe after being on the show someone somewhere will put her on some extreme makeover show or something and get it done for her.  I think insurrance SHOULD cover at least some of it and I think SHE should be willing to do whatever it takes to get it done.  I mean - the doctor couldn't even tell if she has an ulcer or not.

What do you think?

In her case, yes, I think it should be covered.

I think all medically necessary health care should be paid for by the government, so maybe I'm the wrong pinko canuck to be answering this, but here goes...

Of course it should be covered. First of all, she has just saved her insurance company hundreds of thousands of dollars in future expenses by losing 200 lbs. Second, all that skin does put her at risk for repeated infections, ulcers, rashes, etc. Not to mention quality of life.

This ain't vanity. That should be fairly obvious.

I thought this was unreasonable for the insurance company to turn down. I felt so sorry for her. Even her thighs had lose, flappy skin hanging between her knees. They said she had fungi growing in there and her back skin was causing pain.

But, when you live in a country where medical care is a business, and insurance companies just care about profits, you're going to have issues like this.

In the case of your tummy, yes. Its not just that its unsightly, it can cause lower back problems if theres a lot there, not to mention all the other problems listed above.

Great now Im thinking about the fight I may have ahead of me - I have 170 something pounds to lose. =(

I very much agree with TrustWoman.

Also you said "However, I also think that she is insane for not covering it herself after the insurrance company said no". What makes you think she can? There may be other options, but her specific situation in life may prevent those from being reality. I guess we just shouldn't assume that she could afford it another way.

Kerry, you are young and losing weight gradually. I doubt that you will have such results. Often those who drop weight very fast (due to bariatric surgery or such) have far more extra skin than those who do it slowly and gradually (most of your skin is alive, remember, and to some extent remodels itself to fit).

In the UK the NHS sometimes covers a tummy tuck or reconstructive surgery after someone has lost a tremendous amount of weight.

Once i have reached my target i am going to apply for abdominal reconstructive surgery. Of course you'll see that by that time the NHS has gone belly up and everyone requires private health care...

I saw it too, I felt so badly for her.  I hope someone from one of those makeover shows was watching that could help her.

My first thought: Well, if you didn't allow yourself to get morbidly obese in the first place, you wouldn't have the problem.

2nd: Get a second and third job to get rid of that stuff removed.  I kind of feel that insurance is not responsible for your mistakes.

Fallingstars, I think that people make mistakes. I believe in second chances.

Also, if insurance isn't responsible for mistakes, then I suppose they shouldn't pay when people make mistakes and cut off a finger while cooking. I get what you're saying, but if people get insurance to cover it when they smoke 2 packs a day and eventually need to be on oxygen, and insurance covers that, I don't see why it shouldn't cover this. Overweight people do end up paying more in health care costs in the long run, anyway.

Wow, fallingstars, I didn't think I'd ever see that level of ignorance on CC.

If insurance didn't cover people's mistakes, about 90% of procedures would not be covered. A few examples:

- lung cancer treatment for smokers, and/or people who live in cities (living in a city is a guarantee of having greyish-black lungs whether you smoke or not) and, of course, no treatment EVER for coal miners.
- most emergency room visits (falls, car accidents, etc.) After all, it is a mistake to get into a car or climb a ladder if you cannot afford all the possible consequences.
- medical treatment of any kind after being in a fight, or after being abused by a partner
-melanoma removal for those who suntan
-burns caused by hair dyes or the like
- anything to do with eating disorders or, for that matter, most mental illnesses

I'm having a hard time thinking of very many medical conditions that do not directly or indirectly stem from people's choices.

Yeesh.

Suzi,

Maybe she can't - I am basing it off of her clothing and her car and her house and thinking that the surgery itself is about the same cost as a car so really, if she has a car....

Of course, maybe she couldn't.  It is TV afterall.  I'm just shocked that she didn't even go to that thought.. saving the money... asking about what financial help there might me, etc.   I do think insurance should cover it either way so it's kinda a moot point I guess - I just think that if it was me, I'd jump to the moon or do whatever it took to get rid of that.

You know, if insurance was being consistant, they DO cover the gastric bypass surgery so they can't just say that it was her fault getting fat in the first place so we'll ignore any health complications that come from being fat.  I mean, if they did that, they could stop covering a LOT.  So they DO cover health problems from getting fat, just not, apparently, from getting fat and then getting thin again.

I'd be happy if you could pay for the skin removal with pre-tax dollars from the flex spending account, but we can't even do that.  I guess once something is termed "cosmetic" it is vainty no matter what.  I am hoping that I can get these red cheeks treated with a dermatologist through insurance... HEY... maybe she should visit a dermatologist!

Fallingstars727 - When you accidently fall down and hurt yourself do you pay for it out of pocket or use insurance? If you mistakenly hit someones car, do you just fork over some cash or do you let insurance handle it?

While I respect your right to your opinion...I have issues with it. Enough said.

Obesity...America's Epidemic....That's all we hear on TV.  And when we do something about it, we're still getting screwed.  I'd rather be fat than look like a blob.

Jenn, as far as I'm concerned, I'd rather be healthy and have lots of skin than be obese and have diabetes, cardiovascular disease and mobility problems well before my time.

I agree that reconstructive surgery should be more available, but the possibility of skin folds should not be a deterrent to living a healthier lifestyle and reaching a healthy weight. Besides, when the weight is lost through lifestyle changes and not surgery, the amount and severity of extra skin are lessened.

The thing is, some levels of cosmetic surgery are covered by many insurances.  For instance, reconstructive facial surgery for a car accident victim.  My grandmother's insurance covered her breast implants because she had to have a mastectomy.  My dad's insurance sent him to a plastic surgeon after he got his finger tips cut off by a lawn mower (his own stupidity).  Something like this should be covered, while I believe that random nose jobs, breast implants, and facelifts on healthy people should not.

"Well, if you didn't allow yourself to get morbidly obese in the first place, you wouldn't have the problem."

I could not disagree more. There are SEVERAL reasons behind someone being that obese.. medical, psychiatric, etc.

On top of that.. even if you DO believe that.. she also overcame all of that and lost 200 lbs. She deserves credit for that.

That was a particularly ignorant statement, I feel.

Oh... and ALSO..

as to insurance paying for your mistakes..

She PAYS for insurance. One way or another.. whether it be through employment or out of pocket. Insurance is FOR mistakes. Car insurance is a great example. You make a mistake and get into an accident. You are insured for that very reason.

So, she pays for health insurance.. and has made a HUGE step to BE healthy.. and yet her HEALTH insurance cares nothing for her actual health. Why even have insurance then?

If a doctor has recommended it, yes. Insurance will even cover a boob job if a woman has had breast cancer and had hers removed.. because it harms women so mentally. All that flabby skin would not only harm someone mentally, it's also a health risk.


Fallingstars727, not everyone is obese because they "let themselves get that way". I'm considered obese and have 100+ pounds to lose, and I have NEVER been skinny. There was never a point in time where I just "let myself" get this way, because I've always been this way. And I'm only 18 years old, so until only recently have I been smart/mature enough to take matters into my own hands to fix it. There are many health reasons why some people are obese. She deserves credit for losing so much.

Fallingstars727: I found your comment interesting about her getting herself in the mess she should get herself out of it-I am paraphrasing but I believe we are on the same page.-With that thought process should insurance deny people AIDS medication and treatment because they got themselves in their mess? After all, in most cases they did not take percausions in preventing this nearly 100% preventable illness.  Our Surgen General of the USA consider obesity a dissese, therefore shouldn't insurance cover it and all treatments related in the full recovery of it?  Just a thought-

I also saw this episode and wonder if we have all the facts--This woman, who made great progress, still has a lot of weight to take off. She by no means was done with her weight loss.  Maybe the insurance denied her because they feel she needed to take more weight off. I guess it would be nice to know the whole story instead of being left to storyline editing.