how would medicaid determine if a breast augmentation and tummy tuck is deemed medically neccesary?
Breast Augmentation and Tummy Tuck Ever Medically Necessary?
Doctor Answers 25
Medicaid won't and shouldn't cover cosmetic surgery
I would be very shocked to find any third party payor covering such surgery on the basis of medical necessity, let alone a government sponsored program like Medicaid. Unfortunately those programs are designed to meet only the basic medical needs of the indigent who depend upon them, and it is unfair to expect the tax payers of our country to foot the bill for elective aesthetic surgery when so many other more serious medical needs go unmet due to limited resources.
Cosmetic procedures are not covered by medicaid
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I can not imagine that breast augmentation or a tummy tuck would ever be considered to be medically necessary
Insurance and BA
This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses
Is breast augmentation or tummy tuck surgery ever covered by insurance?
Breast Augmentation & Tummy Tuck Are Not Generally Viewed as Medically Necessary by Insurance
Breast augmentation and tummy tuck are not usually viewed as medically necessary by insurance carriers. These procedures are usually part of the Mommy Make-Over, and are viewed as cosmetic.
Occasionally, breast augmentation may be considered medically necessary when done to correct severe breast asymmetry. Occasionally, removal of excess abdominal skin following massive weight loss may be considered medically necessary. These examples are the exceptions and not the rule. Insurance coverage of these procedures would be extremely rare in most cases.
Breast Augmentation and Tummy Tuck not medically necessary
Both breast augmentation and tummy tuck surgery are cosmetic in nature, therefore, most insurance companies or Medicaid would not cover these two procedures. The only time I have heard of this was years ago for spouses in the military.
Breast Augmentation and Tummy Tuck Ever Medically Necessar
These procedures are purely cosmetic and are not covered by any insurance plans. Sometimes breast reductions and breast reconstructions after cancer are covered by insurance companies. All cosmetic procedures are not considered medically necessary and are therefore not covered by insurance.
Breast Augmentation and Tummy Tuck Surgery are Cosmetic; However, Breast Reconstruction or Reduction May be Covered
Both breast augmentation and tummy tuck surgery are cosmetic in nature; therefore, insurance or Medicaid would not cover these two procedures. Though some plans may cover conditions such as breast reduction and breast reconstruction surgery after breast cancer treatment in some cases.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.