Panniculectomy and insurance: Will health first Medicaid pay for skin removal? (Photo)

Dear Beauty199292,
it is hard to tell for sure without an examination. If you have a well documented history of symptoms caused by your excess skin, there is a chance that insurance will cover the costs of your surgery. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Congratulations on your impressive weight loss! Your insurance may cover a panniculectomy if it can be deemed medically necessary. For a more complete result you may want to consider a tummy tuck. This not only would remove excess fat and skin, it would also correct abdominal wall laxity. The result would be a flatter tighter tummy.

Hello, and thank you for your question regarding insurance coverage for a panniculectomy with Health First Medicaid. Based on your photos, it does not appear that your pannus (excess skin) covers your pubic region, which is a requirement for some insurance companies. However, every insurance provider has different criteria, and the fact that you have documented medical issues—such as rashes, infections, and hygiene concerns—may support your case for coverage.

Most insurance companies, including Medicaid, require proof that your excess skin is causing medical complications that have not improved with conservative treatment. This means you will likely need medical records showing repeated doctor visits for rashes, skin infections, chronic moisture buildup, or pain. Many insurance plans also require at least six months of documented treatment, which may include prescription creams, antibiotics, or hygiene regimens.

Additionally, some insurance plans have BMI requirements or stipulate that your weight must be stable for a certain period (typically 6-12 months) before approving a panniculectomy. Since you have maintained your weight loss for eight years and are in good health, this may work in your favor.

To determine if Health First Medicaid will cover your panniculectomy, I recommend the following steps:

Consult with a board-certified plastic surgeon who accepts Medicaid and is experienced in insurance-covered panniculectomies. They can evaluate whether your case meets the necessary criteria.
Obtain medical documentation from your primary care doctor, dermatologist, or any other specialist who has treated your rashes or infections. This should include notes on symptoms, prescribed treatments, and photos of affected areas.
Have your surgeon submit a pre-authorization request to Health First Medicaid, including a letter of medical necessity explaining how the procedure will improve your health.
Contact Health First Medicaid directly to ask about their specific coverage criteria for panniculectomy and whether your current medical history qualifies.
If your panniculectomy is denied, you may be able to appeal the decision with additional medical records or by requesting an evaluation from a Medicaid-approved plastic surgeon.

While insurance coverage is never guaranteed, your documented history of health issues improves your chances of approval. I encourage you to pursue a consultation with an experienced plastic surgeon who can guide you through the insurance process.

I hope this information helps. Best of luck in navigating your insurance approval for a panniculectomy!

Sincerely,
Dr. J. Timothy Katzen, MD, MBA, FACS, FICS