Sagging Breast and Loose Skin After Gastric Bypass Will Medicaid Pay to Remove This?

Question

I am going to get gastric bypass I am 63bmi and I am worried about the sagging empty skin that is to come from rapidly loosing weight. I have caresource (cincinnati) which is like medicaid I would like to know if they typically pay for something like this. If not is there a way to get a payment plan?

J. Timothy Katzen, MD, FACS · Answer

In my 15 years experience of performing reconstructive plastic surgery after massive weight loss, I have found that the only thing Medicare might cover after massive weight loss is breast reduction. Authorization depends on an individual basis and cannot be guaranteed. Authorization is dependent upon your height and weight,  anticipated amount of weight to be resected from each breast,  and presence of rashes, among other things. Please seek a board-certified plastic surgeon who is experienced in breast reduction and lifts surgery after massive weight loss. In addition please seek a board-certified plastic surgeon who is willing to work with you and Medicaid.  
Good luck with your weight loss journey. If you have any questions, please contact my office. Sincerely, Dr. Katzen

Richard J. Bruneteau, MD · Answer

It's not unusual for patients to develop breast sag following massive weight loss. This may occur after gastric bypass surgery or dieting alone. When this situation arises, patients frequently request either breast reduction or breast lift procedures.Breast reduction surgery is often covered by insurance companies, but breast lift is never covered by these carriers. Some insurance companies actually exclude breast reduction as a contract exclusion. When insurance carriers cover breast reduction, they may have specific criteria that must be met. For instance, most insurance carriers require documentation of symptoms. Examples would include back pain, shoulder pain, breast pain and headaches, to name a few. They also require documentation of attempted non-surgical management of symptoms. Examples might include physical therapy, support devices and anti-inflammatory drugs. Some insurance carriers require a minimal amount of breast tissue removal from each breast. This is often based on calculations, which utilize the patient's weight and height.The process starts with a consultation. At that time, pictures are taken and a prior authorization letter is sent for approval. It typically takes about six weeks to obtain a response. If your insurance carrier's criteria are met, you are ready to schedule surgery.

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question! Surgical procedures for aesthetic 
purposes, to improve appearance, are not covered by insurance. 
Typically, these as well as complications resulting from such procedures
 are the responsibility of the patient. Procedures that are meant to 
correct functional issues and those which cause health-related issues 
should be covered by your insurance as a medical necessity, with proper 
examination and documentation.  Some insurance plans have exclusion 
criteria for certain procedures.  Also, it is an obligation of the 
surgeon not to attempt to authorize purely cosmetic procedures through 
insurance.   These procedures are typically not covered after massive weight loss.  Discuss your issues and 
complaints with a board-certified plastic surgeon to discuss these as 
well as to examine and assist you in deciding which procedure(s) will be
 the best for you. A discussion of the advantages and disadvantages will
 take place along with the risks and benefits. Insurance companies will 
vary on coverage and is always reasonable to discuss your issues with 
your surgeon and primary care. It would behoove you to get as much 
information as possible and even call your insurance yourself. 
Certainly, pay in advance prior to your surgical procedure and options 
such as financing are available if you qualify. Hope that this helps! 
 Best wishes!

C. Bob Basu, MD, MPH, FACS · Answer

Breast lift procedures are deemed not medically indicated and are usually classified as a cosmetic procedures.  Hence, insurance companies do not cover breast lifts.

Darryl J. Blinski, MD · Answer

No, health insurance does not cover cosmetic operations. Care Credit is the most common financing plan used.

Kim-Chi Vu, MD · Answer

After gastric bypass surgery, patient generally ends up having very loose and saggy skin and tissues, affecting the breasts, arms, abdomen, trunks and thigh/leg region. Patient would likely benefit body contouring surgery which may include but not limited to breast lift surgery, arm surgery (brachioplasty), excisional removal of excess skin and fat of the abdomen, back, trunk, sometimes total body lift, and thigh lift. Whether or not these procedures will be covered by insurance depend on your plan. Most insurance consider Post bariatric body contour surgery to be "cosmetic" and not reconstructive in nature. Thus, most insurances will not cover these. However, if there are medical issues associated with this conditions, and your surgeon may feel there is a medical necessity to have these surgeries performed, then I think it would be worth your time and your surgeon to make an effort submitting prior authorization request for the surgery. It does not hurt to submit in your request. If your insurance denies it, then you would have to pay yourself.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Congratulations on your decision to proceed with gastric bypass surgery;  hopefully you will have a very successful operation and subsequent weight loss.

	Generally, most patients who experience very significant weight loss after gastric bypass surgery benefit from breast lifting ( and usually breast implants as well). I have not seen these procedures covered by any type of health insurance plan.

	Of course it would be in your best interest to check with your specific plan but I would find it very unlikely that this procedure will be covered.

	Best wishes.

Edward J. Domanskis, MD (in memoriam) · Answer

We always try to get coverage of procedures after bariatric surgery and excess weight loss. We send photos in/letters. This process does take much time but it is worth it to cut costs. If this does not help, then we do offer several payment options and even give substantial discounts to patients willing to appear on TV or are in military.

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