Is follow-up surgery to remove loose skin covered?
Panniculectomy (removal of loose skin) is covered following bariatric surgery for a medical condition only when specific medical criteria are met (contact Customer Service at 1-888-849-3681). Most panniculectomies are considered cosmetic and are not covered.
If you decide to pay for this surgery yourself, most plastic surgeons require that you wait two to three years following significant weight loss before performing skin removal surgery. This is because the skin tends to tighten somewhat over time. Complications arising directly from services that are not covered by the plan are not a covered benefit.
Under what circumstances might reoperation be covered?
Reoperation for significant medical complications as listed below following bariatric surgery may be covered when determined to be medically necessary under plan medical policy:
- Band migration (slippage) that cannot be corrected with manipulation or adjustment
- Bowel perforation, including band erosion
- Leak
- Obstruction
- Staple-line failure
- Weight loss of 20% or more below ideal body weight
- Stricture
Reoperation in the absence of the complications listed above does not qualify for coverage, including but not limited to the following conditions:
- Early satiety
- Failure to lose weight
- Nausea
- Patient dissatisfaction
- Gastroesophageal Reflux Disease (GERD)
- Conversion of a prior procedure to a different procedure (e.g., laparoscopic adjustable banding to gastric bypass)
When might a revision to a previous bariatric surgery be covered?
The member must apply for coverage and follow all UMP criteria for bariatric surgery. Only those bariatric procedures normally covered by the plans will be considered.