Had gastric bypass surgery 15yrs ago. Work out, at an ideal weight. But still have sagging breasts, arms, thighs, abdomen.

I am disabled at the present time. I have Medicare as my primary insurance, and Medicaid as my secondary. My question is will they pay for a breast implant, a tummy tuck, brachioplasty, and thighs? I am at an ideal weight for my height, and I do workout faithfully, to no avail. I do get rashes in the areas of my abdomen and thighs from time to time, which I clear on my own with triple antibiotic. Please let me know if there is any hope that my insurances will pay to help me?

Doctor Answers 2

Insurance may cover a panniculectomy but not a tummy tuck

Thank you for your question.  Insurance does not cover a tummy tuck, breast lift or breast implants.  In certain situations, they may cover a panniculectomy which is removing the fold of skin only without tightening the muscles or moving the belly button as is done with a tummy tuck.  It can be a functional procedure to treat skin rashes caused by the folds of skin.  

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Insurance coverage of body contouring after weight loss

Congratulations on your weight loss and sustaining it over the years. 

The issue of sagging skin after weight loss is very common and the breasts, tummy, arms, and thighs are frequent areas of concern.  Unfortunately, insurance does not pay for cosmetic surgery to remove loose skin, even in patients who have lost a lot of weight.  In some cases Medicare and other insurers will pay for a panniculectomy, which is an operation on the abdomen to remove hanging skin.  It is not a tummy tuck, as it does not contour the entire abdomen but rather just removes the skin and fat that hangs at the bottom.  Insurance coverage of a panniculectomy typically requires that a patient have rashes or infections between the skin folds of the lower abdomen that are documented in their medical records (i.e. not just something that is easily taken care of by the patient at home) that consistently recur or fail to respond to appropriate medical treatment.

It sounds like you may have symptoms that could help you get Medicare coverage of a panniculectomy.  I would start by seeing your primary care doctor when you have rashes so that your symptoms and treatment can be documented.  Once you've done this a few times, have your doctor refer you to a plastic surgeon to discuss a panniculectomy.  Bring the medical records from your primary care doctor's office that pertain to your symptoms and treatment so the plastic surgeon can review them.  I'm sure the surgeon would be happy to talk to you about your other areas of concern, but their treatment is almost certainly going to be an out-of-pocket expense for you.

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.