Liposuction and Medicaid coverage for medical reason?

Question

I am 33 and 5'1 and about 135 lbs. Endometriosis is stage 4. I've had 7 surgeries for the issue including a partial hysterectomy. I flare a lot and deal with consistent issues with back, abdominal and sciatic nerve pain. It can be so debilitating that I am bed ridden. I am often in too much pain to work out (exercise) and my stomach is my trouble area. What is the possibility of Medicaid covering the surgery because the pain from the endo greatly impedes my working out. I eat healthy as well.

Paul F. Vanek Jr, MD · Answer

All insurance covered treatments require a medical diagnosis and a five digit CPt code to bill and code for insurance. Cosmetic procedures are not considered candidates for insurance reimbursement. Your pain syndrome related to endometriosis will not allow a treatment with Cosmetic liposuction.  Despite your belief that reducing your abdominal and trunk will make you happy- it won’t be covered by your insurance.

Donovan Rosas, MD · Answer

Insurance will not cover elective cosmetic procedures. In order to obtain coverage, one must prove medical necessity. Patients must document the actual medical problems which liposuction will address.It is also important to remember that liposuction is not a means to weight loss. It is a contouring tool to address problem areas which have been resistant to diet and exercise.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Don Fontana, MD · Answer

Despite having sincere issues and concerns, the chances of Medicaid covering a liposuction procedure is zero. Check with a nearby teaching hospital where there is a training program in Plastic Surgery. They may offer you this procedure at a significantly lower cost.

Nick Masri, MD, FACS · Answer

Thanks for your question, candacehazzard.
One of the requirements before getting a liposuction is that you must be in an overall good state of health. With your endometriosis bothering you, I personally don’t think it’s a good idea to undergo liposuction. 
After all, liposuction is not a weight loss procedure, and it is very seldom that it’s covered by Medicaid or any other insurance provider. Unless liposuction is going to relieve symptoms of endometriosis, I don’t see why insurance companies would cover your liposuction.
Still, the best thing to do is to consult a reputable and board-certified plastic surgeon and have yourself personally evaluated.
Best of luck!

Liposuction and Medicaid coverage for medical reason?

Answers (4)