Will any insurance and/or Medicare help me financially with medical suggested Liposuction or Tummy Tuck? (Photos)

Question

My Dr. thinks that Liposuction/tummy tuck wld help me tremendously. I hv scoliosis, w/dble twisted curve, I'm 68. Failed back surgery,then pain pump. Rmvd problems w/pump/meds-Morphine then Dilauded. Now hv elec stim. w/epiderals 2x/yr. Both knees replaced. Fibromyalgia. I'm 5'3"-245 lbs. Therapy many times, w/little/no results. Use walker for short distances. Longer use wheelchair/scooter. Cannot do any exercises-back goes into terrible spasms, then I'm laid up in bed for a couple days.

Jason Emer, MD · Answer

Very rarely will insurance cover cosmetic treamtents unless there is a morbidity associated (ie infections, life is affected etc).  Please speak to your physician.  Best, Dr. Emer.

Mats Hagstrom, MD (license on probation) · Answer

Insurance covers medically indicated conditions.This is generally not include any corrections in body contouring.It does however at times cover procedures that can help with skin infections or pain control.I have never seen a medical insurance company pay for liposuction for any type of weight reduction, pain management or other treatment indication.Medical insurance does pay for a partial abdominoplasty call the panniculectomy from time to time.Unlike a full abdominoplasty I panniculectomy is more of an amputation of the skin that hangs on the lower abdomen.It does not given the same aesthetic result but does remove the lower hanging skin.This procedure is generally indicated for patients who have chronic skin infections that cannot be treated any other way.The procedure requires substantial amounts of documentation and meeting certain criteria in order for insurance companies to authorize it.Medicare does not give pre-authorization and has the right to deny payment for the procedure after-the-fact if not medically indicated.This puts patients at a potential risk for having denied payments of the procedure after the surgery.Talk to a few plastic surgeons and ask if anyone of them is willing to work on getting preauthorization.This can also be done by any doctors such as your primary care physician. Obtaining insurance authorization for procedures such as a panniculectomy can be a real hard for me.Insurance companies will almost always attempt to deny authorization the first time around.This usually requires multiple letters addressing each reason the insurance company denies the procedure.You will often go to something called manual review requiring a doctor to doctor conversation between the plastic surgeon and Dr. working for the insurance company trying to maintain cost control over medical expenses.The reimbursement for this procedure is probably about 20% of what was plastic surgeons would charge if it was done as a cosmetic operation.because the low reimbursement from insurance companies many plastic surgeons maybe apprehensive or not willing to perform insurance based surgeries such as this one.There are however many many plastic surgeons who perform insurance based procedures on a regular basis and you should not have a difficult time finding one but I suggest having a few consultations.It will require a plastic surgeon who serves as a patient advocate and is willing to spend a considerable amount of time arguing with the insurance company.You may or may not meet the criteria for having this done but it's worth looking into.Panniculectomy is never covered to control pain but only to treat skin infections.Best of luck,Mats Hagstrom M.D.

Will any insurance and/or Medicare help me financially with medical suggested Liposuction or Tummy Tuck? (Photos)

Answers (2)

Recommended reading

Everything you need to know about Liposuction

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

Will any insurance and/or Medicare help me financially with medical suggested Liposuction or Tummy Tuck? (Photos)

Answers (2)

Browse related questions

Recommended reading

Everything you need to know about Liposuction

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