Can A Tummy Tuck Or Panniculectomy Be Covered By OHIP?

By Jerome Edelstein, MD

Medical insurance may cover the cost for some post- weight loss surgical procedures. Ontario’s OHIP coverage does not pay for cosmetic surgery unless medically necessary.

In Ontario, surgery to assist with weight loss, also called bariatric surgery, is covered by OHIP. Qualifications for this coverage include: failing to lose weight through a medically supervised program and having a BMI or body mass index over 40.

Bariatric surgeries may involve reducing the stomach’s capacity with the application of a band, removal of part of the stomach, or bypassing part of the intestines to reduce nutrient absorption. This surgical solution is not the first step, but will be considered after trying medications and other diet assistance. Because it can lead to increased mobility and improve many aspects of one’s health, bariatric surgery is often considered medically necessary and can even be life-saving. Bariatric surgery should be accompanied by counseling and guidance for long term maintenance, including post weight loss skin removal surgery if required.

There are a few surgical options to address excess skin which can often remain after the success of a bariatric procedure and drastic weight loss. Both abdominoplasty and panniculectomy can effectively remove the excess abdominal skin or, “apron” left after weight loss, however, the two procedures are different.

They are different in relation to medical insurance coverage as abdominoplasty is not covered by OHIP. Though there is a component of skin removal, the abdominoplasty or “tummy tuck” also allows for fat removal through liposuction, contouring and sculpting, abdominal muscle tightening, and belly button reconstruction. Abdominoplasty is often very transformative and can greatly improve confidence and comfort. The psychological and emotional benefits that this procedure can offer, however, it is not considered medically necessary.

Panniculectomy surgery, which simply refers to the surgical removal of a pannus or skin apron, is sometimes covered by OHIP. It is important to note that panniculectomy procedures do not include muscle tightening, waist slimming, and supplementary liposuction.

Qualifications for this coverage may include weight loss of 100 lbs or more and excess skin which hangs down below the pubis. Skin breakdown issues such as rashes and ulcers can be caused by rolls of excess skin, creasing, and friction.

The abdominal pannus resulting from massive weight loss can weigh from 5 pounds to more than 100 pounds, so the removal of this through panniculectomy can have significant health benefits and be considered medically necessary.

Liposuction is a body sculpting, cosmetic, surgical procedure used to remove excess fat and pockets of fat from various areas of the body. Liposuction is not appropriate for trying to lose weight, rather it is used for shaping and smoothing of contours. This procedure is purely cosmetic and not considered for medical insurance coverage.

Talk with your primary care doctor about the best options for you.