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.

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 (3)