What do I need that Medicaid will most likely cover? Interested in panniculectomy and abdominoplasty. (photos)

Question

I have lost 85 pounds. I have paramount advantage Medicaid insurance(Ohio)they cover a panniculectomy and an abdominoplasty. While meeting specific criteria of course, for a medical necessity. IF IM approved. I am trying to prepare for all I need to prepare for. Don’t I need a Fleur-de-lis abdominoplasty. Any surgeons successful with approval of Medicaid patients getting this done? If they deny abdominoplasty and just approve panniculectomy , is there a Fleur-de-lis panniculectomy procedure?

Kenneth Hughes, MD · Answer

Medicaid will not cover a tummy tuck but could possibly cover the panniculectomy. The panniculectomy involves only the removal of excess skin/fat that hangs over the genitals and/or thighs. It does address hygiene issues, rashes/infections, etc. When a panniculectomy is done, there is no tightening of the underlying muscles and tapering of the waist so you do not get the contour shape. Panniculectomy is only the removal of the skin below the belly button, so the best aesthetic results could be attained with a TT.

J. Timothy Katzen, MD, FACS · Answer

Hello Optimistic101522 in Toledo, OH, 
Thank you for your question regarding what do I need that Medicaid will most likely cover and the fact that you are Interested in panniculectomy and abdominoplasty.  Thank you for your history and your pictures.  Usually, for your insurance company to cover and pay for a panniculectomy, you need to meet the following criteria: 1) your abdominal pannus must hang below level of pubis        or pelvic bone 2) ideally, your BMI should be 30 or less; however, the pannus may make this impossible. 3) if you lost more than 100+ lbs with diet and exercise, you must be at a stable weight for 6 months. If you lost more than 100+ lbs with weight loss surgery, then your weight must be stable for 18 months 4) you must have a documented history (in doctor’s office) of recurrent rashes or non-healing ulcers that are not respondent to antibiotic, antifungal, or steroid creams and 5) you must have documented difficulty with ambulation or interference with activities of daily living.   A panniculectomy solely performed for the correction of low-back pain is considered NOT medically necessary and usually not covered.   
Your optimal procedure would be an extended abdominoplasty (hip to hip).  This should be combined with upper abdominal liposuction or a reverse tummy tuck.  Some plastic surgeons call the standard tummy when it is combined with a reverse tummy tuck, an "I" tummy tuck because the incision looks like the capital letter "I".  Most plastic surgeons would agree that you do not need a Fleur-de-lis abdominoplasty.  However, if you wanted, you could have a panniculectomy combined with a Fleur-de-lis abdominoplasty.  Technically, there is no such thing a Fleur-de-lis panniculectomy, but there is a panniculectomy with Fleur-de-lis abdominoplasty.  Usually, Medicare does approve the Fleur-de-lis abdominoplasty.  Most plastic surgeons offer free virtual or in-office physical consultations.  Therefore, explore what other plastic surgeons have to say.  Good luck.  I hope that I have answered your question regarding what you need that Medicaid will most likely cover and the fact that you are Interested in panniculectomy and abdominoplasty.  If you have any more questions regarding the panniculectomy, belt abdominoplasty, or belt dermolipectomy, contact an experienced plastic surgeon. Since the panniculectomy or abdominoplasty is a big procedure, please seek an experienced, board certified plastic surgeon with significant experience performing the panniculectomy or lower body lift. Do your research.  Make sure they have performed at least 100 panniculectomies or tummy tuck surgeries and have the before-and-after pictures to prove it.  Carefully examine their before-and-after pictures and check their reviews on RealSelf.   If you cannot find an experienced, panniculectomy or tummy tuck surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen, MD. MBA, FACS, FICS. (Plastic Surgeon, President of  the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Daniel Barrett, MD · Answer

Dear Optimistic101522,
if your loose skin is causing symptoms, there is a chance that insurance will cover the costs of surgery. However, they don't cover the costs of tummy tuck. 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

Camille Cash, MD · Answer

Insurance will not cover an abdominoplasty..  That is considered a cosmetic, elective procedure.  A panniculectomy needs to be deemed medically necessary in order to have coverage.  It will remove the hanging apron of skin essentially from hip to hip.  Common factors that deem it medically necessary along with the physical exam are chronic rashes and infections.

What do I need that Medicaid will most likely cover? Interested in panniculectomy and abdominoplasty. (photos)

Answers (4)

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