After weight loss surgery will the state of Illinois pay for skin removal or body contouring?

Question

David Shifrin, MD · Answer

insurance companies will pay for medically necessary procedures. That includes breast reductions and panniculectomies where indicated. Where indicated is determined by each insurance company. In general though, breast reductions require a specific amount of tissue to be removed and panniculectomies require documentation of chronic irritation and infections in the crease between the skin flap and your private area. Most patients want cosmetic improvements after massive weight loss. The above procedures are designed to prevent medical problems, not improve appearance. There is a huge difference between a panniculectomy and a tummy tuck or body lift. If you have state provided insurance (Medicaid) their determination system is generally less stringent and relies solely on the practitioners opinion. The caveat there is that the reimbursement for the procedure is so poor that the work becomes charity and most providers are unable to do charity work 100 % of the time. You may have better luck finding a surgeon to do your procedures through a resident clinic if that’s is your goal. Best

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding insurance coverage for skin removal or body contouring after weight loss surgery. In Illinois, as in most states, insurance coverage for procedures like skin removal or body contouring depends on whether the surgery is deemed medically necessary or cosmetic.

For skin removal to be covered by Medicaid or private insurance in Illinois, you would need to demonstrate that the excess skin is causing significant medical issues. Common issues that qualify include:

Chronic rashes or skin infections under the skin folds that do not improve with medical treatment.
Pain or discomfort that affects your mobility or ability to perform daily activities.
Skin breakdown leading to sores or ulcers.
If these medical issues are documented by your physician, there is a possibility that skin removal surgery, such as a panniculectomy, could be covered. A panniculectomy involves removing the excess skin from the lower abdomen and is often covered if it’s causing medical complications.

However, procedures like body contouring, which include more cosmetic enhancements such as tummy tucks or thigh lifts, are usually not covered by insurance, as they are considered elective and non-essential for health.

To increase your chances of insurance approval, it’s essential to work with your healthcare providers to document any health-related issues caused by the excess skin. You may also need to provide photographic evidence and letters of medical necessity from your doctor.

I recommend contacting your insurance provider directly to discuss coverage options and required documentation. This will help clarify the specific steps you need to take to pursue skin removal surgery.

Sincerely,
Dr. Katzen

Nelson Castillo, MD · Answer

Thank you for sharing your question and congratulations on your weight loss!  For most states the only covered procedures may be a breast reduction or panniculectomy.  You would need to check on the policy in Illinois as well as the criteria needed to obtain coverage.  Hope this helps.

After weight loss surgery will the state of Illinois pay for skin removal or body contouring?

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After weight loss surgery will the state of Illinois pay for skin removal or body contouring?

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Everything you need to know about Body Lift

Our mission is to create a world where every investment in modern beauty is Worth It.