Mons Pubis liposuction and lift not for cosmetic reasons. Help

Question

I have always had a large mons pubis. I get a lot of irritation and pain. After childbirth the area got bigger and now sags more than ever. Now the skin gets in the way of urination, causing a mess and constantly having to wash after I use the washroom. I can not sit for long as I have to lean back on my tailbone to take pressure off my pubic area or I end up with pain that feels like bruising under the skin. Would healthcare insurance cover this or a portion to have corrected?

Richard Greco, MD · Answer

Many patients have a very full Mons - and sometimes a very loose and redundant  area that is hidden under  the patient's abdominal wall laxity/redundancy.  If it is not identified before the abdominoplasty or Around the World belt lipectomy - the patient will have a bulge postoperatively.  Many patients will ask where it came from - and often they call it their "package".It is important to discuss this area with the patient preoperatively - so that it can be adressed with by liposuction or reduction surgically.  You can go to our website to look at some result - mycosmeticsurgeon.md Rarely, will insurance consider this an insurable event.

Dallas Buchanan, MD · Answer

Thank you for your question. Sorry to hear you are having problems with this area. There are surgical options to treat that area, but insurance coverage would be a big question. Most insurance companies would consider this type of surgery cosmetic. But you could always see a local plastic surgeon who was willing to submit it to insurance for approval. Best of luck!

Sanjay Azad, MS, FRCSEd · Answer

Thank you for your question and I believe you are looking for correction of an irritated mons pubis. Typically our health care system in Canada will not cover this type of surgery. More often than not a large mons pubis needs concomitant correction of the tummy with a simultaneous tummy tuck and the mons. 
The mons at this combined procedure is reduced in height due to the low scar on the pubic area. Also liposuction or direct removal of fat is done to give a much more pleasing and trouble free contour. 
In Ontario we do not have code for this procedure and I would have thought that Alberta would be using the same generic system.
You are best served in having a full consult with the appropriate plastic surgeon and getting a proper assessment to sort you physical issues out.
I do hope this is helpful in your endeavours.

Gustavo E. Galante, MD · Answer

Insurance coverage for this would depend on your plan's benefits, and you would need to see a surgeon that accepts that insurance.

Mats Hagstrom, MD (license on probation) · Answer

It's very possible that your insurance company would cover this as a medically indicated procedure.
Many plastic surgeons are not interested in performing insurance based procedures because the reimbursement is a tiny fraction of what can be collected from cosmetic surgery.
Treating this as a cosmetic procedure may cost you $10,000 or more.
Insurance reimbursement would probably be around $1000.
That may still seem like a large profit for the doctor.
Consider that many plastic surgeons have monthly overhead's that are well over $35,000 and all of a sudden $1000 for performing a procedure if they could take 4 to 5 hours in total for the doctor makes it a money losing proposition.
All that said, many plastic surgeons do lots of reconstructive surgery excepting insurance conversation.
To get a procedure covered by your insurance company you will probably need to get pre-authorization.
Surgical procedures are either covered or not covered based on certain diagnoses.
For example, if a skin rash can only be treated by skin removal then it should be a covered procedure because treating skin infections should be covered by your insurance company.
In order to get preauthorization your doctor will have to serve as a patient advocate.
It will require that they do a thorough evaluation and request pre-authorization from your insurance company.
For this particular condition or procedure many insurance companies Will automatically deny The procedure.
An appeal maybe necessary including a discussion from your doctor with a representative of your insurance company.
It's important to understand that the time involved in this process it's usually not compensated to the doctor.
If your doctor can make a convincing argument that there is no alternative to treat your skin infections other than the surgical one your insurance company can't really deny you the procedure.
They can try but almost all insurance coverage include the treatment of skin infections as a covered medical benefits.
Some insurance companies will have criteria such as how low the skin hangs in comparison to your private areas.
The bottom line is the squeaky wheel gets the grease.
You need to find a Doctor Who will go to bat for you and work with your insurance company until you get authorization for the procedure.
Your procedure will not be authorized for a fall abdominoplasty.
The procedure is generally referred to as a panniculectomy.
This basically remove the excess skin that's causing the skin reaction.
Consider looking for plastic surgeons working in an academic center or in a major teaching hospital.
Also plastic surgeons who work in large hospitals that take care of trauma often do more reconstructive surgery.
Private practice plastic surgeons Peter mostly to cosmetic surgery are probably not the ones to look for.
I would say that the majority of plastic surgeons who are active on real self Focus more on cosmetic surgery or at least desire to do mostly cosmetic surgery because of financial gains.
Best of luck.
Remember to be persistent and continue requesting consultations until you find someone who's willing to serve as a strong patient advocate.
This is key in obtaining insurance authorization.
Understand that there is a potential Financial gain by most plastic surgeons by not getting insurance authorization.
Best of luck,
Mats Hagstrom M.D.

Mons Pubis liposuction and lift not for cosmetic reasons. Help

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