Medicaid Covered Panniculectomy in Illinois?

Question

I have a referral in hand for a panniculectomy from my primary physician (due to serious back issues) I am having the hardest time finding a surgeon who will accept medicaid... I was able to find one at Southern Illinois University but that is like 6 hours away from me and would make follow ups after surgery really difficult. Does anyone know of a Dr who accepts medicaid for this type of surgery in the Northern Illinois area?

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  I hope that these answers 
help!  A panniculectomy is an excellent method for removing the excess 
skin and soft tissue of the lower abdomen (abdominal panniculus), often 
caused by weight loss.   It is mainly performed to ameliorate symptoms 
caused by the abdominal apron such as hygiene issues, excoriations, 
rashes/infections, back pain, etc.  A panniculectomy gives almost 
immediate relief from these issues as well as has been shown to 
stimulate additional weight loss as your activity level is increased 
after removal of the panniculus.  An abdominoplasty is more of an 
aesthetic procedure in that as opposed to simply excising this excess 
tissue in a wedge to relieve complaints, an abdominoplasty focuses more 
on abdominal contouring, abdominal wall tightening, re-insetting the 
belly button, as well as often times the addition of liposuction.

I would highly recommend continued diet and exercise prior to any 
consideration for a panniculectomy or body contouring as getting down to
 your ideal weight 
prior to the procedure will certainly give you the best results as well 
as be the safest for you.    Neither one is a weight loss procedure.  
Also, a
 continued healthy and active lifestyle will be needed in order to 
maintain the benefits that the procedure has given to you.   You should 
consult with a 
plastic surgeon at anytime to go over options and  in order to assist 
you in 
deciding which procedure(s) would be right one for you.   Depending on 
your examination, photo documentation, and discussion of your symptoms, 
insurance coverage may be possible.   I would begin with calling your insurance plan for recommendations and who is on your plan.  Best wishes for a wonderful result!

Raj S. Ambay, MD · Answer

A referral from your doctor does not mean medicaid will cover any part of your expense. In fact most times medicaid wont give an approval and the accepting doctor does the surgery only to find the procedure is turned down by medicaid after claim submission. The patient does not have money to pay and the doctor pays for surgery out of his own pocket. Unfortunately this is done commonly by the insurance companies including Medicaid and that is part of the reason you are having difficulty not only finding a provider but also finding a provider to respond to your post.

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