After bariatric surgery, patients often experience redundant skin in the upper arms and medial thighs as sequelae of massive weight loss
. Insurance companies have unpredictable criteria to determine the medical necessity of brachioplasty
, which are often ascribed as cosmetic procedures. We evaluated current insurance coverage
and characterized policy criteria for extremity contouring in the postbariatric population.
We conducted a cross-sectional analysis of insurance policies for coverage of brachioplasty
in January 2019. Insurance companies were selected based on their state enrolment data and market share. A web-based search and direct calls were conducted to identify policies. A comprehensive list of standard criteria was compiled based on the policies that offered coverage.
Of the 56 insurance companies assessed, half did not provide coverage for either procedure (n = 28). No single criterion featured universally across brachioplasty
policies. Functional impairment was the most commonly cited condition for preapproval of brachioplasty
(94%). Conversely, minimum weight loss
was the least frequent criterion within the insurance policies (6%). Only 5% of the insurance companies (n = 3) would consider coverage of liposuction-assisted lipectomy
as a modality for brachioplasty
We propose a comprehensive list of reporting recommendations to help optimize authorization of extremity contouring in the postbariatric population. There is great intercompany variation in preapproval criteria for brachioplasty
, illustrating an absence of established recommendations or guidelines. High-level evidence and investigations are needed to ascertain validity of the limited coverage criteria in current use.