Should a panniculectomy/abdominoplasty after massive weight loss be covered by insurance?

Body contouring after massive weight loss (MWL) is a rapidly growing area in Plastic Surgery. Panniculectomy/abdominoplasty is primarily a cosmetic procedure with some functional benefits (a large pannus may hamper mobility, prevent further weight loss, and cause recurrent skin infections) and hence many insurance companies are changing their guidelines to include this as a medical procedure. This study assesses reimbursements for a large academic institution in Massachusetts for panniculectomies/abdominoplasties performed in MWL patients. We performed a retrospective review of charges and reimbursements for panniculectomy/abdominoplasty in MWL patients performed at Lahey Clinic. Records for patients who underwent a "medical" panniculectomy by a single surgeon from August 2002 to August 2006 were reviewed with special emphasis on the charges, reimbursements, insurance carriers, and prior preauthorizations. Fifty-two patients underwent a medical panniculetomy/abdominoplasty (Current Procedural Terminology code 15831) for laxity of skin/pannus as a result of MWL. All patients except Medicare required and obtained precertification for the procedure. Patient ages ranged from 35 to 59 years, which included 42 females and 10 males (n = 52). Forty-three underwent bariatric surgery; their procedures were performed between 13 and 62 months after their initial surgery. Weight loss ranged from 65 to 345 pounds. Body mass index at the time of the surgery ranged from 22 to 48. The standard surgical charge for a medical panniculectomy at Lahey Clinic is $3,086. The range of reimbursements was zero to the full amount with the mean reimbursement of $615 and the median being $899. Reimbursements for panniculectomies are remarkably low and in many instances (35% in our series) absent despite obtaining prior precertification of medical necessity. Although insurance companies have extended their indications for panniculectomy/abdominoplasty, we think that it is a cosmetic procedure. Plastic surgeons must bear these reimbursements in mind when faced with a patient requesting this.