Mommy Makeover: Q&A
Ask a QuestionBreast Augmentation and Tummy Tuck Ever Medically Necessary?
how would medicaid determine if a breast augmentation and tummy tuck is deemed medically neccesary?
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21 Doctor Answers |
Asked by
abell253
in florida
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Medicaid won't and shouldn't cover cosmetic surgery
I would be very shocked to find any third party payor covering such surgery on the basis of medical necessity, let alone a government sponsored program like Medicaid. Unfortunately those programs are designed to meet only the basic medical needs of the indigent who depend upon them, and it is unfair to expect the tax payers of our country to foot the bill for elective aesthetic surgery when so many other more serious medical needs go unmet due to limited resources.
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Breast Augmentation & Tummy Tuck Are Not Generally Viewed as Medically Necessary by Insurance
Breast augmentation and tummy tuck are not usually viewed as medically necessary by insurance carriers. These procedures are usually part of the Mommy Make-Over, and are viewed as cosmetic.
Occasionally, breast augmentation may be considered medically necessary when done to correct severe breast asymmetry. Occasionally, removal of excess abdominal skin following massive weight loss may be considered medically necessary. These examples are the exceptions and not the rule. Insurance coverage...
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Medical necessity
I can not imagine that breast augmentation or a tummy tuck would ever be considered to be medically necessary
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Breast Augmentation and Tummy Tuck not medically necessary
Both breast augmentation and tummy tuck surgery are cosmetic in nature, therefore, most insurance companies or Medicaid would not cover these two procedures. The only time I have heard of this was years ago for spouses in the military.
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Breast Augmentation and Tummy Tuck Ever Medically Necessar
These procedures are purely cosmetic and are not covered by any insurance plans. Sometimes breast reductions and breast reconstructions after cancer are covered by insurance companies. All cosmetic procedures are not considered medically necessary and are therefore not covered by insurance.
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Breast Augmentation and Tummy Tuck Surgery are Cosmetic; However, Breast Reconstruction or Reduction May be Covered
Both breast augmentation and tummy tuck surgery are cosmetic in nature; therefore, insurance or Medicaid would not cover these two procedures. Though some plans may cover conditions such as breast reduction and breast reconstruction surgery after breast cancer treatment in some cases.
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Breast Augmentation and Tummy Tuck with Insurance
Thank you for your question.
Unfortunately, insurance never covers a straight forward breast augmentation or tummy tuck procedure. These are considered "elective, cosmetic" procedures and are not covered by insurance. Breast surgery may be covered if it's reconstruction after cancer or a deformity.
I hope this helps.
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Mommy makeover procedures - cosmetic surgery
Most surgeons refer to a "mommy makeover" as a series of cosmetic surgery procedures intended to restore a woman’s figure after pregnancy. Procedures commonly performed during mommy makeovers include:
Abominoplasty (tummy tuck)Breast Augmentation +/- Lift, or Breast Lift only without implants, liposuction
These procedures will not be covered by insurance.
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Medicaid coverage of abdominoplasty and breast augmentation
It is highly unlikely if Medicaid were to approve a tummy tuck. Several criteria including skin laxity, irritation (erythema intertrigo) skin breakdown, yeast infections, ulcers, ventral hernia, etc would need to be documented. Even if this portion were approved, they would not pay for the rectus muscle repair which is completed in 80-90% of cases and is an essential component of aesthetic abdominoplasty. Forget about coverage for breast implants unless you have documented...
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Doubtful.
Hello,
Understand that insurance companies love to deny anything even remotely cosmetic. They save money that way. It is doubtful you will get these operations covered under health insurance.
Best Regards,
John Di Saia MD
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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