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Medicare and Medicaid Waitimg for Approval Time Plastic Sugery?

How many months or weeks does it take for medicare and medicaid to approve and pay for sugery of breast reduction abdominal plasty tummy tuck panniculectomy and hernia of abdominal area plus I have 3 recents reccommendation letters from three doctors stating it's medically necessary.

Doctor Answers (4)

Medicare and medicaid

+1

Both of these do not pay for cosmetic surgery. There is a lot of stuff patients think they need , but it is elective and they have to pay for it out of pocket.


New York Plastic Surgeon
4.0 out of 5 stars 9 reviews

Medicare does not preauthorize surgery

+1
Medicare reviews cases only after claims have been submitted. Therefore, I do not perform "cosmetic surgery", including the cases you mention, without having the patient sign a waiver stipulating that the charges are cosmetic and receiving payment. One huge issue is that if Medicare denies the procedure, it will make you liable for the fulll hospital and anesthesia charges, not the discounted cosmetic fee. Medicare has paid for breast reduction and hernias but a panniculectomy is cosmetic in 99% of cases and would not be covered.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 12 reviews

Medicare

+1

Procedures cannot be preauthorized with Medicare.  You would have to sign a waiver agreeing to pay all charges if Medicare denies payment.  In my city, you get a discounted rate for cosmetic procedures from the hospital, but if billed to insurance and denied, the hospitals will not retroactively discount their fees and you are left paying list price, which is quite expensive.  Although you have letters from doctors, most insurance companies are not covering these procedures, with the possible exception of a breast reduction and only if you have significant volume removal, not just lifting of the breast. 

I would really caution you about taking the insurance approach for the cosmetic portions of the procedures.  I have heard of patients receiving enormous bills leading to severe financial burdens.

Donald Griffin, MD
Nashville Plastic Surgeon
4.5 out of 5 stars 21 reviews

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Insurance covering Tummy Tuck Surgery, Breast Reduction, Hernia Repair, etc

+1

Thank you for your question.

Each insurance company is different with their authorization process. I do not believe that medicare provides preauthorization and so you will be responsible for full payment if they deny the claim.

 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 759 reviews

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