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!

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

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

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.

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.

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.