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Breast Augmentation and Tummy Tuck Ever Medically Necessary?

asked 2 years ago by abell253 in florida
Latest answer by Tom J. Pousti, MD
Question viewed 1,894 times

how would medicaid determine if a breast augmentation and tummy tuck is deemed medically neccesary?

15 answers to Breast Augmentation and Tummy Tuck Ever Medically Necessary?

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.

Tom J. Pousti, MD
San Diego Plastic Surgeon

www.poustiplasticsurgery.com

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.

C. Bob Basu, MD
Houston Plastic Surgeon

www.basuplasticsurgery.com

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... more

Otto Joseph Placik, MD
Chicago Plastic Surgeon

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

John P. Di Saia, MD
Orange Plastic Surgeon

Insurance and surgery

A tummy tuck and a breast augmentation are two operations that are elective cosmetic surgeries that as far as I know are not covered by insurance.

Steven Wallach, MD
Manhattan Plastic Surgeon

Would Medicaid / CalAid / TennCare Pay for my Breast Augmentation and Tummy Tuck?

Regarding: "Breast Augmentation and Tummy Tuck Ever Medically Necessary? how would medicaid determine if a breast augmentation and tummy tuck is deemed medically neccesary?" Medicaid was created on July 30, 1965, through Title XIX of the Social Security Act to provide BASIC care to needy (poor or disabled) American. While each states manages its own Medicaid program (giving rise to MediCal, MassHealth, TennCare etc), they are being monitored by the HUGE central agency ,... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

Breast augmentation and abdominoplasty are cosmetic procedures

Insurance companies will often determine coverage based on whether or not a procedure is medically necessary. This is as opposed to cosmetic procedures, such as breast augmentation and abdominoplasty, which are not medically necessary and not covered.

Olivia Hutchinson, MD
New York Plastic Surgeon

Tummy tuck and breast augmentation: COSMETIC

Breast augmentation would only be considered medically necessary when done as part of a breast reconstruction after breast cancer. Otherwise, tummy tucks and breast augmentations are cosmetic without question. No insurance company would cover the cost.

Carmen Kavali, MD
Atlanta Plastic Surgeon

Breast augmentation and tummy tuck as a medically necessary

A breast augmentation is never covered by insurance. Breast reconstruction with implants after a mastectomy usually is. A tummy tuck might be covered if there is a massive overhan of skin and fat causing symptoms.

Howard T. Bellin, MD
Manhattan Plastic Surgeon

Medical indications for breast augment and tummy tuck

Insurance has covered a breast augmentation for the chest deformity known as Poland's Syndrome and to treat the contralateral breast after breast cancer and reconstruction. So insurance coverage is not impossible but only indicated for specific medical diagnosis. Insurance has also covered a panniculectomy, which many people would consider a tummy tuck, when medical problems of the skin under the abdominal skin apron have failed conservative treatments and this has been... more

John K. Long, MD
Houston Plastic Surgeon

Cosmetic vs. reconstructive surgery

Augmentation mammaplasty is a cosmetic procedure and not covered by insurance, unless it is part of an overall plan for reconstruction after mastectomy for breast cancer. A tummy tuck is also cosmetic, although if severe skin breakdown occurs as a result of overhanging skin, a panniculectomy, which is a more limited operation, would be covered.

Paul W. Loewenstein, MD
Milwaukee Plastic Surgeon

Cosmetic surgery and Medicaid

Medicaid does not cover cosmetic surgery. You may qualify for a panniculectomy of skin/fat apron removal, but not a tummy tuck

Scott E. Kasden, MD
Dallas Plastic Surgeon

Cosmetic surgery

If these orocedures are done for cosmetic enhancement of a normal body then they are cosmetic in nature and not covered by insurance.

Samir Shureih, MD
Baltimore Plastic Surgeon

BREAST AUGMENTATION AND TUMMY TUCK ARE CONSIDERED COSMETIC SURGERY

Breast augmentation and tummy tuck are both cosmetic and not medical in nature. Since these procedures are not treating or correcting a medical condition, they are not covered by insurance.

Michael A. Jazayeri, MD
Santa Ana Plastic Surgeon

Insurance coverage of breast augmentation and abdominoplasty

If the surgery is done as part of a treatment plan for cancer. Otherwise they are cosmetic procedures and there is no reason why taxpayers should cover the bill through medicaid.