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Post Bariatric Plastic Surgery Insurance Questions?

On November 2nd, 2011 I had the gastric bypass surgery. I was 388 pounds+ and I've lost almost 200 pounds. I plan on losing 50 more pounds. I'm looking for a plastic surgeon or cosmetic surgeon who accept Medicare and Medicaid to pay for, at least partially, a tummy tuck and a breast reduction. I actually need more than a breast reduction, but I won't get into that here. I reside in the Tampa area:)

Doctor Answers (7)

Post-bariatric plastic surgery insurance questions?

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Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.  It is very unlikely that either of those insurance plans will cover those procedures nor will even authorize.  That being said, it is possible that they will not cover, in which case, you would be responsible for the entire procedure and all costs - certainly a risk for you.

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!


Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Post Bariatric Plastic Surgery Insurance Questions

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Congratulations on the weight loss to date. Insurance coverage for post weight loss procedures is rather sporadic and unpredictable. For Medicare and Medicaid the problem is compounded by the fact that you cannot find out in advance if you are covered. It is unlikely that you will find a surgeon, hospital or surgicenter willing to risk not getting reimbursement. 

My suggestion would be to consult with the plastic surgery resident clinic at the University Medical Center, where the clinic has likely dealt with this issue before and may be able to help.

All the best

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 31 reviews

Medicare tummy tuck

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The reality is that fewer and fewer surgeons will take medicare let alone medicaid.The new health care law will increase costs to a large extent and the providers who will accept an expanded medicaid patient base will decline.The cost of providing the service is GREATER than what the insurance will pay.You should call soem offices first to see who will take it.I think it is great you have lost so much weight Congratulations.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 19 reviews

Good Luck

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To the best of my knowledge, neither of these insurances will cover what you want done. And if they did, they pay so little, no one I know will accept payment from them for this work.
 

William B. Rosenblatt, MD
New York Plastic Surgeon
4.0 out of 5 stars 9 reviews

Congratulations on your weight loss!!

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That is a great accomplishment! It is frustrating to go through all of that and then not be able to have insurance help pay for it. In our practice, the surgery is rarely ever reimbursed by Medicare. It will almost never be paid for by Medicaid. As has been mentioned, there is no way to get preapproval. There may be a way to get your money refunded if a portion of the procedure gets ultimately paid by the company. Best of Luck!

M. Scott Haydon, MD
Austin Plastic Surgeon
5.0 out of 5 stars 41 reviews

Post Bariatric surgery questions

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You may have a difficult time finding a surgeon to perform essentially cosmetic surgery under any insurance plan.  The problem with medicare is that they will not approve anything in advance.  Best to check with a local surgeon and get his opinion as to medical necessity.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 9 reviews

Post bariatric insurance questions

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Most insurance companies do not cover the post bariatric plastic surgery procedures unless there are medical reasons for the procedure. ie if your breasts are large enough for the insurance company to say you are large enough medically to benefit from it. for the abdomen usually they require failed treatment from rashs due to overhanging skin. It is a difficult position. We as surgeons feel they should cover it, but they do not agree. Good luck. I would see a surgeon soon, and plan for the future.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 9 reviews

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.