Arm lift medical necessity?

Question

I am just starting my surgery journey after losing about 150 pounds. I am having my abdomen done first. My surgeon then plans to do an arm lift/ breast reduction/lift. I know my insurance won’t pay for it. I am wondering what would qualify this procedure for FMLA. I do have back pain, rashes and get fungal infections from the excessive skin. I am hoping these will qualify for it. I am qualified for fmla for my abdominal surgery with some of the same complaints.

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding the medical necessity of an arm lift and its qualification for FMLA.

Congratulations on your significant weight loss and embarking on your surgery journey. Good luck with your upcoming tummy tuck, arm lift, and breast reduction/lift.

Most plastic surgeons will complete the necessary paperwork for FMLA even if your procedure is not covered by insurance. Therefore, even if your arm lift is not covered by insurance, your plastic surgeon usually will still complete the FMLA paperwork. Given your history of back pain, rashes, and fungal infections from excessive skin, these complaints should help support your FMLA qualification.

Good luck. I wish you success in your tummy tuck, arm lift, brachioplasty, and mastopexy. I hope that I have answered your question regarding FMLA.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic Surgeon

Azita Madjidi, MD, MS, FACS · Answer

Arm lift is not covered by insurance even if you have difficulty with clothing, rash etc. Some works accept FMLA for arm lift even if it is not covered by insurance. Some don't.

Ryan Rebowe, MD · Answer

While abdominal skin removal is approved for surgery on a relatively common bases, resection of skin from other parts of the body is typically not covered. Even with severe symptoms, this is usually not considered medically necessary. However, just because insurance will not cover the procedure does not mean it will not help. I would continue to explore your options for payment even if insurance does not cover the procedure, as this is likely to benefit you in the long run.

Connie Hiers, MD, FACS · Answer

The arm tuck is never considered medically necessary, but the abdominoplasty may be for those who have lost over 100 pounds and have documented 3 months of treating the rash and fungal infections with their primary care physician.

Scott C. Lindsay, DO · Answer

Hello, thank you for your question.  If you give your surgeon your FMLA paperwork they would be able to fill this out completely for you.  Due to the fact you are having surgery this should be covered under FMLA.  I doubt you can use short term disability and still get paid for an Arm lift, but I do know my office gets paperwork approved for STD for a Tummy Tuck. Worse case is if FMLA is not approved you can get ADA which is an accommodation disability act form. Best of Luck!

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  From your description it sounds as though the procedures you are considering will benefit you.  Your surgeon is not able to determine if you will or will not be approved for FMLA benefits, but can provide findings after a physical evaluation.  I encourage you to speak with your HR department for specifics.

Arm lift medical necessity?

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