SHOULD A PANNICULECTOMY/ABDOMINOPLASTY AFTER MASSIVE WEIGHT LOSS BE COVERED BY INSURANCE
PURPOSE
Body contouring after massive weight loss (MWL) is a rapidly growing area in the field of plastic surgery.
According to the American Society for Bariatric Surgery, approximately 170,000 bariatric cases were done in 2005. The laxity of skin has resulted in a surge of body contouring procedures most of which are cosmetic in nature. 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.
The purpose of this study is to assess reimbursements for a large academic institution in the state of Massachusetts for panniculectomies/abdominoplasties performed in MWL patients.
METHODS
We performed a retrospective review of charges and reimbursements for panniculectomy/abdominoplasty in MWL patients performed at the Lahey Clinic. Records for all 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. Patients’ information with respect to mode of weight loss, amount of weight loss and BMI at the time of the panniculectomy was assessed. Fifty two patients underwent a medical panniculetomy/abdominoplasty (CPT 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 thirty to fifty-nine years, which included forty-two females and ten males (n=52). Forty-three underwent bariatric surgery, and nine lost weight through diet and exercise. In those that had bariatric surgery_the procedures were performed between 13 and 62 months after their initial surgery.
RESULTS
Weight loss ranged from sixty five to three hundred and forty five pounds. BMI at the time of the surgery ranged from twenty-two to forty-eight. Nine patients had other concomitant procedures.
The standard surgical charge for a medical panniculectomy at the Lahey Clinic is $3086.00. The range of reimbursements was zero to the full amount with the mean reimbursement of $615 and the median being $899.
Table 1- Amount being reimbursed versus number of patients

Amount reimbursed (0	No. of patients
0	18
1-500	3
501-1000	13
1001-1500	16
1501-3000	0
>3000	2

Table 2: Reimbursements of individual insurance companies

Insurance Company	Mean (0	Median (0
Harvard Pilgrim HMO (n=9)	723	971
Blue Cross/Blue Shield (n=19)	897	1017
Medicaid (n=7)	0	0
Medicare (n=9)	668	374
Others (n=8)	567	1,000

CONCLUSION
Reimbursements for panniculectomies are remarkably low and in many instances (34% 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.