Will Medicaid cover a Panniculectomy? (Photo)

Question

I have very low hanging apron belly and want it gone. Have back issues and getting hernia surgery this month.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding if Medicaid will cover a panniculectomy. I have indeed seen Medicaid cover a panniculectomy. It will be important to keep good medical records of your pain, rashes, hernias, etc. I recommend visiting your primary care doctor each time there's an issue so it can be logged into your medical records.

Usually, for your insurance company to cover and pay for a panniculectomy, you need to meet the following criteria: 1) your abdominal pannus must hang below level of pubis or pelvic bone 2) if you lost more than 100+ lbs with diet and exercise, you must be at a stable weight for 6 months. Suppose you lost more than 100+ lbs with weight loss surgery. In that case, your weight must be stable for 18 months 3) you must have a documented history (in doctor’s office) of recurrent rashes or non-healing ulcers that are not respondent to an antibiotic, antifungal, or steroid creams and 4) you must have documented difficulty with ambulation or interference with activities of daily living. A panniculectomy solely performed for the correction of low-back pain is considered NOT medically necessary and usually not covered.

I specialize in reconstructive plastic surgery after weight loss.  If you have any more questions regarding the panniculectomy, extended lower body lift, lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact my office. Since the panniculectomy or lower body lift is a big procedure, please seek an experienced, board certified plastic surgeon with significant experience performing the panniculectomy or lower body lift. Do your research.  Make sure they have performed at least 100 panniculectomies or circumferential lower body lift surgeries and have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.   If you cannot find an experienced, panniculectomy or lower body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and ​member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Kenneth Hughes, MD · Answer

Medicaid could possibly cover the panniculectomy. The panniculectomy involves only the removal of excess skin/fat that hangs over the genitals and/or thighs. It does address hygiene issues, rashes/infections, etc. When a panniculectomy is done, there is no tightening of the underlying muscles and tapering of the waist so you do not get the contour shape. Panniculectomy is only the removal of the skin below the belly button, so the best aesthetic results could be attained with a TT.

Will Medicaid cover a Panniculectomy? (Photo)

Answers (2)

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