I have Medicaid and Medicare and medical issues due to excess skin how do I get my insurance to help pay?

Question

I’ve lost over 100 pounds and my excess skin is crazy. I can’t breathe because it hangs so heavily and low. I keep getting rashes in my belly button. I barely have feeling in my skin due to 4 repeat c-secs so I zip my skin up all the time and am left with sores. I absolutely have no money for a tummy tuck. I need help.

Jeffrey D. Wagner, MD · Answer

Thank you for this question.  In some cases of major weight loss causing excess skin that is causing significant medical problems, insurance payers will cover removal, i.e., panniculectomy.  On the other hand, cosmetic abdominoplasty is virtually never covered by insurance.  Many (probably most) cases are borderline, so preauthorization is strongly advised to assure payment.  Unfortunately, at least in my experience, many insurance companies (despite what they may tell you over the phone) are reluctant to consider most of these cases as medically necessary or to give preauthorization for payment. Others, such as traditional Medicare, do not even have a preauthorization process, so you don't really even know if it will be covered beforehand.  When insurance does pay, the reimbursement for these services may be very low.  For these reasons many plastic surgeons are reluctant to perform such cases through the insurance route.  I recommend you research this topic by visiting a board certified plastic surgeon with experience in post bariatric surgery.  I hope this helps.

Maximilian Malotky, MD · Answer

Thanks for your question hindingundermyskin, I'm sorry you are afflicted with all the excess skin after weight loss but I would like to congratulate you on your incredible and healthy transformation.  Insurance will NEVER cover an abdominoplasty (removing skin from above the belly button down to the mons area) as they consider it 100% cosmetic.  Occasionally, they will cover a panniculectomy (removing excess tissue between the belly button and mons).  This doesn't yield as great a cosmetic result but it can definitely help with the rash symptoms and sores (I would not expect a change in breathing from this or any abdominal procedure).  The insurance companies are getting more and more strict on their requirements but usually you will need documentation (from primary care and/or other physicians besides your plastic surgeon) of >100lb weight loss, stable weight for >6m, rashes/infections/wounds that have been medically treated, and a photo of the extent of the excessive skin at minimum.  The surgeon will bill the insurance company for your panniculectomy, but if they decide not to pay for any reason then you could be left with the bill.  As mentioned before, a preauthorization can help protect you, but even this is no guarantee of payment and medicare does not even allow preauthorizations. It is a very sticky situation, but I recommend seeking out a board certified plastic surgeon on plasticsurgery.org who has experience with body contouring after massive weight loss so they can help walk you though this journey and be your advocate.  I wish you the best of luck!
Dr. Max

Nick Masri, MD, FACS · Answer

Thanks for your question, hidingundermyskin. I’m sorry to hear about your health problems.
Although tummy tuck is seldom covered by insurance like Medicaid and Medicare, I think you can present a good case so that you can have them shoulder all or part of your plastic surgery. You might qualify for a panniculectomy, which removes excess skin and fatty tissues in the abdomen, although it doesn’t involve muscle tightening.
To do that, make sure that you provide proper documentation of your condition to your insurance company.  Take photos of your sores and rashes, plus get referrals and certifications from physicians saying that you tried all other non-surgical procedures to remedy your condition, but to no avail.
It’s also important to look for a reputable and board-certified plastic surgeon who has experience in handling such cases, as he may be able to assist you in procuring coverage for your panniculectomy.
Best of luck!

I have Medicaid and Medicare and medical issues due to excess skin how do I get my insurance to help pay?

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I have Medicaid and Medicare and medical issues due to excess skin how do I get my insurance to help pay?

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Everything you need to know about Tummy Tuck

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