Medicaid will sometimes cover excess skin removal after weight loss surgery. The bariatric procedure type does not matter (gastric bypass, lap band, vertical sleeve, or gastric balloon).
The medical necessity of each procedure is of far greater importance as it dictates whether your publicly-funded health insurance will pay claims.
Skin removal for cosmetic reasons (improved appearance) is not medically necessary. The surgery must treat an illness or correct a functional impairment.
The rules vary by state and body part: abdomen, arms, legs, breasts, face, and neck.
Therefore, verify the criteria used by your plan and have your plastic surgeon submit documentation for pre-certification.
Abdominoplasty & Medicaid Coverage
Medicaid does not cover excess skin removal surgery after weight loss when the provider performs an Abdominoplasty (Tummy Tuck) to reduce the flabby epidermis from your midsection. The procedure is never medically necessary.
Payment Plans
Without a medically necessary reason, Medicaid will not cover excess skin removal from your belly or any other body part (arm, leg, neck, face, or breast). Therefore, you might need to find alternatives.
Cosmetic surgery financing for bad credit might be a better avenue for formerly obese patients seeking to improve their appearance. However, low-income adults should budget carefully before signing up for a payment plan.
Combination Procedures
Medicaid does not cover Abdominoplasty to remove loose skin because this procedure always falls into the cosmetic category with no expectations – even with muscle tightening to address back pain or prevent future hernias.
Medicaid might cover some tummy tuck costs when performed simultaneously with a second medically necessary operation. You might be able to spend less by sharing expenses with one of these procedures.
- Hysterectomy
- Tubal Ligation
- Hernia Repair
- Liposuction
Panniculectomy Covered by Medicaid
Medicaid often covers surplus skin removal surgery after weight loss when the provider performs a Panniculectomy: excision of the panniculus (an apron of the excessive abdominal epidermis or subcutaneous tissue).
Local Providers
Recipients seeking a nearby Panniculectomy covered by Medicaid must find a plastic surgeon accepting their plan who can compile and document the medically necessary reasons for the procedure.
You can find local plastic surgeons that take Medicaid by following the appropriate resource given the type of plan you have: PPO or HMO.
- PPO recipients should consult the online provider directory published by their MCO or state agency. Input your zip code and select plastic surgery as the specialty, and the system should output a list.
- HMO recipients should schedule an appointment with their Primary Care Provider (PCP), who must diagnose the illness (cellulitis, skin ulcers, etc.) or functional impairment and refer them to a local plastic surgeon in the HMO network.
How To Get Covered
To get Medicaid to cover Panniculectomy, you must document that the procedure is medically necessary. The evidence might include standing photographs and medical records of previous treatments for designated conditions.
Your state’s Panniculectomy rules might follow criteria similar to these.
- The panniculus hangs at or below the level of the pubic symphysis, causing cellulitis, skin ulcerations, or persistent dermatitis that has failed to respond to at least three months of non-surgical treatment.
- Antibiotics
- Antifungals
- Good hygiene
- Dressing changes
- Or the panniculus causes a functional impairment (complete or partial loss of function of a body part), and the Panniculetomy is expected to correct the problem.
You may also have to show a stable weight for the last six months and wait eighteen months after bariatric surgery.
Brachioplasty & Thighplasty Medicaid Coverage
Medicaid will sometimes cover excess skin removal surgery after weight loss when the plastic surgeon performs a Brachioplasty (upper arm lift) or Thighplasty (upper leg lift). We need our limbs to function correctly.
A medically necessary Brachioplasty might fit criteria similar to these.
- Friction causes left-over tissue to complicate wound healing
- Skin folds interfere with normal activities of daily living
- Bathing
- Dressing
- Toileting
- Eating
- Hygiene
- Skin folds cause rashes and irritation
Rhytidectomy & Medicaid Coverage
Medicaid rarely covers excess facial skin removal. A Rhytidectomy (neck and face lift) almost always falls into the cosmetic category after significant weight loss from an earlier bariatric procedure.
However, hope is not lost. Sometimes, a Rhytidectomy is medically necessary or reconstructive rather than cosmetic.
A medically necessary or reconstructive Rhytidectomy might fit these criteria.
- Improve a significant functional impairment
- Speech
- Nutrition
- Control of secretions
- Airway protection
- Corneal protection
- Address a significant variation from normal related to:
- Accidents or trauma
- Disease or congenital defects
- Treatment of disease (obesity)
Mastopexy & Medicaid Coverage
Medicaid rarely covers excess skin removal after weight loss when your provider performs a Mastopexy (breast lift). This procedure is always deemed cosmetic because raising breast tissue improves appearance without addressing a medical problem or functional impairment.
However, Medicaid might cover Mammoplasty (breast reduction), which removes unwanted skin that causes a functional impairment in daily activities.
- Headaches
- Pain in shoulders, neck, upper back
- Kyphosis (spinal curvature) documented by X-rays
- Ulceration from bra straps
- Skin breakdown from overlaying tissue
- Upper extremity paresthesia (prickling sensation in arms)
