Tummy Tuck With Medicaid? The majority of insurance providers do not typically cover a tummy tuck, as it is considered a purely cosmetic procedure. But Medicare and Medicaid can shoulder a portion of your procedure, provided that you can prove with proper documentation that the surgery is medically necessary.
The tummy tuck procedure has two phases. Your surgeon will contour your belly by tightening the underlying abdominal muscles. Then, they will remove excess skin to make your midsection appear and feel firm.
Tummy Tuck With Medicaid
There are significant life events that can negatively affect our body, particularly our midsection. Pregnancy, major weight loss, aging, and surgery in the area can affect the look and feel of your abdomen. And sadly, they cannot be addressed by exercise and diet alone.
A tummy tuck procedure in San Diego can solve these issues by targeting loose abdominal muscles, mild to significant skin laxity, and excess fat. It can even simultaneously remove stretch marks located below the navel.
Insurance Coverage For A Tummy Tuck
Even though most private insurance companies do not cover tummy tucks, you might be surprised to find out that Medicaid and Medicare may cover some costs of your surgery. However, if your need for the procedure is purely for cosmetic reasons, your insurance will never cover this.
Since a tummy tuck is usually considered elective cosmetic surgery, you will have to prove to Medicare that it is a medically necessary procedure. Medical necessity means that your loose skin gets in the way of performing your daily activities.
Medicare requires that you have a stable weight for at least six months. Moreover, you should explore other ways to address your loose skin in the abdomen for at least three months. You should make sure that your progress is documented by a physician who will then recommend the surgery.
Just like Medicare, Medicaid may also cover a portion of your tummy tuck surgery if excess abdominal skin after a massive weight loss negatively affects your daily life. It also requires documentation from a surgeon who can prove that you have had any of the following:
- Pain in the abdominal pannus and/or lower back
- Impaired ambulation
- Interference with personal hygiene
- Signs and symptoms of panniculitis
- Large redundant fold of skin and fat hanging below the groin
- Recurrent intertrigo to the overhanging pannus resulting in skin infections
- Body Mass Index greater than thirty (30)
- Presence of lymphedema, abscesses, or hernias
- Documentation of size and configuration of pannus as evidenced in photographs.
The tummy tuck procedure has two phases. Your surgeon will contour your belly by tightening the underlying abdominal muscles. Then, they will remove excess skin to make your midsection appear and feel firm. Only the second phase will be covered by insurance as loose skin exposes you to risks of rashes and infection. Frequently, insurance coverage is limited to a panniculectomy alone. This involves removing the excess lower abdominal skin only. It is important to find a provider who contracts with Medicare/Medicaid to see if you are a candidate. Marin Aesthetics does not partner with either of these programs.
Will Medicaid Pay For Panniculectomy
Panniculectomy is a surgery done to remove stretched out, excess fat and overhanging skin from your abdomen. This can occur after a person undergoes massive weight loss. The skin may hang down and cover your thighs and genitals. Surgery to remove this skin helps improve your health and appearance.
Panniculectomy is different from abdominoplasty. In abdominoplasty, your surgeon will remove extra fat and also tighten your abdominal (belly) muscles. Sometimes, both types of surgery are performed at the same time.
Description
The surgery will take place in a hospital or a surgery center. This surgery may take several hours.
- You will receive general anesthesia. This will keep you asleep and pain-free during the procedure.
- The surgeon may make a cut from under your breast bone to just above your pelvic bone.
- A horizontal cut is made in your lower belly, just above the pubic area.
- The surgeon will remove the overhanging extra skin and fat, called an apron or pannus.
- The surgeon will close your cut with sutures (stitches).
- Small tubes, called drains, may be inserted to allow fluid to drain out of the wound as the area heals. These will be removed later.
- A dressing will be placed over your abdomen. You may need to wear a binder.
Why the Procedure Is Performed
When you lose a lot of weight, such as 100 pounds (45 kg) or more after bariatric surgery, your skin may not be elastic enough to shrink back to its natural shape. This can cause the skin to sag and hang. It may cover your thighs and genitals. This extra skin can make it hard to keep yourself clean and to walk and perform daily activities. It also can cause rashes or sores. Clothing may not fit properly.
Panniculectomy is done to remove this extra skin (pannus). This can help you feel better about yourself and feel more confident in your appearance. Removing extra skin also may reduce your risk for rashes and infection.
Risks
Risks of anesthesia and surgery in general are:
- Reactions to medicines
- Breathing problems
- Bleeding, blood clots, or infection
Risks of this surgery are:
- Scarring
- Infection
- Nerve damage
- Loose skin
- Skin loss
- Poor wound healing
- Fluid buildup under the skin
- Tissue death
Before the Procedure
Your surgeon will ask about your detailed medical history. The surgeon will examine the excess skin and old scars, if any. Tell your doctor about any prescription and over-the-counter medicines, herbs, or supplements you are taking.
Your doctor will ask you to quit smoking if you smoke. Smoking slows recovery and increases the risks of problems. Your doctor will suggest you quit smoking before having this surgery.
During the week before your surgery:
- Several days before surgery, you may be asked to stop taking medicines that make it hard for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and others.
- Ask your doctor about medicines you should still take on the day of your surgery.
On the day of surgery:
- Follow instructions about when to stop eating and drinking.
- Take the medicines your surgeon told you to take with a small sip of water.
- Arrive at the hospital on time.
Note that panniculectomy is not always covered by health insurance. It is mostly a cosmetic procedure done to change your appearance. If it is done for a medical reason, such as hernia, your bills may be covered by your insurance company. Be sure to check with your insurance company before the surgery to find out about your benefits.
After the Procedure
You will need to stay at hospital for about two days after the surgery. You may need to stay longer if your surgery is more complex.
After you recover from the anesthesia, you will be asked to get up to walk a few steps.
You will have pain and swelling for days after surgery. Your doctor will give you pain killers to help relieve the pain. You may also experience numbness, bruising, and tiredness during that time. It may help to rest with your legs and hips bent during recovery to reduce pressure on your abdomen.
After a day or so, your doctor may have you wear an elastic support, like a girdle, to provide extra support while you heal.
Can A Tummy Tuck Be Medically Necessary
Stress incontinence: This often occurs due to weakened abdominal muscles and an increase of pressure on the bladder. Incontinence can result in the inability to control your bladder during certain situations, including coughing, sneezing, or laughing
For men and women everywhere, the tummy tuck can truly be a life-changing procedure.
So what does a tummy tuck do, and what are the medical reasons for tummy tuck surgery? Board-certified plastic surgeon Dr. Sean Kelishadi is proud to correct both cosmetic and functional issues through this simple procedure. If you would like to learn more about tummy tuck benefits in Newport Beach, CA, contact us today for a personalized consultation. We are excited to offer tummy tucks in your area.
What is a tummy tuck?
This is done by removing extra skin and tightening the underlying abdominal muscles. Often, Dr. Kelishadi will employ liposuction along with a tummy tuck to eliminate stubborn areas of fat, further enhancing the results of the procedure.
What does a tummy tuck do?
The tummy tuck is primarily considered a cosmetic procedure, and patients are surprised to see how much can be achieved through surgery. By undergoing a tummy tuck, patients can get rid of loose, stretched out skin, and enjoy the results of their hard work.
So what else does a tummy tuck do? Women who have gone through multiple pregnancies also pursue tummy tuck surgery to address loose skin and weakened abdominal muscles. Loose abdominal muscles are also known as diastasis recti, and this commonly occurs shortly after pregnancy. During tummy tuck surgery, Dr. Kelishadi tightens the underlying muscles to restore the abdomen back to its original position. In some cases, the results are even better than before!
Medical reasons for tummy tuck surgery
Even though tummy tuck procedures are widely performed for aesthetic reasons in Newport Beach, CA, they have an impressive list of medical and functional benefits. Here is a simple list of medical issues a tummy tuck may correct in patients:
- Stress incontinence: This often occurs due to weakened abdominal muscles and an increase of pressure on the bladder. Incontinence can result in the inability to control your bladder during certain situations, including coughing, sneezing, or laughing. This commonly affects women shortly after pregnancy and childbirth. In some cases, tightening the abdominal muscles may improve urinary continence.
- Hernia: A hernia takes place when the intestines push through a weak spot in the walls of the muscle tissue. This may happen as a result of pregnancy and childbirth, as well as significant weight fluctuation. A tummy tuck procedure can bring the abdominal muscles back together.
- Back problems: Loose abdominal skin can lead to bad posture, back pain, and a host of other uncomfortable issues. If your core is weak and unable to effectively support the heavy, sagging skin, your body may begin to compensate with poor posture, which leads to aches and pains. By removing the extra tissue, a tummy tuck can restore your mobility and improve your posture once again.
Can I combine this surgery with other procedures?
Many patients at SSK Plastic Surgery want to know if they can combine their tummy tuck with other procedures to maximize their results. Many women choose to combine other procedures with their tummy tuck. A great example is the mommy makeover, which sometimes combines breast augmentation, tummy tuck surgery, and liposuction so women can refresh their appearance and restore their pre-baby bodies. When you visit our plastic surgery clinic in Newport Beach, Dr. Kelishadi can make recommendations based on your current state and aesthetic goals. We can also discuss medical reasons for tummy tuck surgery.