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

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

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.

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!