Tummy tuck after weight loss

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In the past, if an employee has gone through a weight loss medical proceedure or weight loss program because a doctor diagnosed a medical condition such as hypertension or diabetes or heart trouble etc., we have allowed "tummy tucks" and other skin tightening procedures to be reimbursed because the need ultimately resulted from a medical condition. Is this allowable?

In a current case, there is a woman who has on her own as far as we can tell, through diet and exercise, lost a lot of weight and now desires a tummy tuck to take in all the loose skin. Her doctor is telling her this can be reimbursed but we don't think so unless the weight loss portion came about because a doctor said there was a medical condition requiring it and prescribed it. They are also trying to separate out the anesthesthetics for the proceedure, saying that it should be reimbursed anyway regardless.

What is the rule here?

Thanks

[Guest Sieve]

I don't think it matters whether the weight loss came from a medical procedure, or from a doctor-recommended activity to ameliorate a chronic medical condition (e.g., diabetes), or just because the individual wanted to lose weight. The issue, I believe, is whether the surgery now proposed is a deductible medical expense, i.e. if it is an expense for "diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body".

So, if the doctor gives a written determination that such-and-such will occur without the tummy tuck (e.g., chronic infections leading to XXXX), or that not performing a tummy tuck will produce a significant medical condition that will need treatment and the surgery mitigates the treatment or prevents the need for the treatment, then you have a deductible medical expense and a reimburseable cafe plan expense.

It would be liket the difference between a nose job to mitigate chronic breathing problems, or a nose job to reshape the nose because you don't like the way it looks--if this tummy tuck is like the former nose job scenario, then FSA reimbursement is OK; if it's like the latter, then No.

[LRDG]

With respect to the initial weight loss, it's possible a doc would have perscribed weight loss to treat onset diabetes, or heart disease or another medical condition. But that is not known and if I understand your comments, it doesn't really mattter because there is no claim for the cost of weight loss treatment.

IRC Sec. 213 describes medical expenses that are eligible for reimbursement from health insurance plans, eligible as a medical expense that is deductible from an individual tax returns, and expenses eligible for reimbursement from a Medical FSA under a Sec. 125 plan.

Expenses must be medically necessary; can not be purely cosmetic in nature or for the improvement of general health and well being; must be for treatment of illness, injury, diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.

If as a result of un-Dx, un-Rx'ed weight loss, her doc is rx-ing corrective surgery because the patient will develope or has developed a medical condition resulting from excessive skin, it would meet requirements of 'medically necessary' and would be more than 'for general health and well being', nor would it be considered purely cosmetic in nature.

Cosmetic surgery is in some cases an eligible expense if it is to treat an underlying illness or to correct defect or deformity, congenital or the result of trama.

IRS eligible medical expenses are described in Sec. 213 of the IRC.