1) No Scenario (the most likely) - the skin removal is for cosmetic purposes. This is generally understood to extend to persons who have meaningful weight loss that leaves them with excess skin. So, you may have done the right thing by losing a lot of weight but you may have to reconcile yourself to living longer with a flabbier body or privately pay for cosmetic surgery.
2) Yes Scenario (uncommon but not rare) - where medically necessary criteria are met. There are circumstances where there can be recurring health problems caused by skin overhang (yeast infections, sores and rashes, infections, etc.) that can be remedied or mitigated by removing the overhanging skin, a Panniculectomy. This is not the same procedure as what is commonly referred to as a "tummy tuck."
The Punniculectomy only removes the overhanging skin and does not address the stretching of abdominal muscle that can also occur and which is commonly addressed in the "tummy tuck" procedure. As such, depending upon the terms of your policy and how a claim is coded I can foresee the situation where both procedures are performed (if the doctors went on and did the more invasive abdominal muscle procedures while "they were in there" and this was done with your prior consent or request) and part of the procedure is covered by the policy and the other part being deemed for cosmetic purposes and not being covered.
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1) No Scenario (the most likely) - the skin removal is for cosmetic purposes. This is generally understood to extend to persons who have meaningful weight loss that leaves them with excess skin. So, you may have done the right thing by losing a lot of weight but you may have to reconcile yourself to living longer with a flabbier body or privately pay for cosmetic surgery.
2) Yes Scenario (uncommon but not rare) - where medically necessary criteria are met. There are circumstances where there can be recurring health problems caused by skin overhang (yeast infections, sores and rashes, infections, etc.) that can be remedied or mitigated by removing the overhanging skin, a Panniculectomy. This is not the same procedure as what is commonly referred to as a "tummy tuck."
The Punniculectomy only removes the overhanging skin and does not address the stretching of abdominal muscle that can also occur and which is commonly addressed in the "tummy tuck" procedure. As such, depending upon the terms of your policy and how a claim is coded I can foresee the situation where both procedures are performed (if the doctors went on and did the more invasive abdominal muscle procedures while "they were in there" and this was done with your prior consent or request) and part of the procedure is covered by the policy and the other part being deemed for cosmetic purposes and not being covered.