Attention: would like to hear from anyone who has had Medicare cover plastic surgery after...

I am in the process of getting the necessary psych.eval and medical tests prior to a surgery date. I have already had my consult with Dr. Zahn and their office has assured me that with Medicare there is no problem "it's easy" is what I have been told and I obviously must have enough co-morbidities that they are confident that the surgery will be paid for. To be honest, the WLS itself is not my major concern. It is the surgeries that will be needed after the weight has been lost, that I am most concerned about. The tummy tuck, breast job, arms, etc...) I am on SSDI because of SLE and because of my obesity as well, and the only insurance that I have is Medicare. According to my Medicare carrier (Blue Cross,Blue Shield) no medical treatment is pre-authorized. When I asked about whether or not abdominalplasty was covered through them I was told no it was not, yet at the same time the woman I spoke with stated that if a physician stated the procedure was medically necessary and the medical records showed this to be true then there was a possibility of it being covered. I have heard/read that people have had plastic surgeries covered while on Medicare and I have also heard/read that there are those who have not had these surgeries covered. I don't know what to believe or to expect at this point. I do know that I will have a lot of work that needs to be done after I lose the weight and have real worries about this. I would really appreciate hearing from any one who has had WLS and been able to get Medicare to pay for the necessary plastic surgeries after reaching their goal weight. I think it would be just awful to finally lose all the weight and have no way to get rid of all the loose skin afterwards. Almost makes me want to just say "forget it!" Thank you very much for any info you can share with me about your own experiences. Hope to hear from you soon!!

I have Medicare as my primary insurance and Tricare Prime (military) as my secondary. Here is what I can tell you that I have been told. The reason that Medicare will pay for your WLS, is because the government has stated that obesity is a desease, therefore, your WLS will be paid. Now reconstructive surgery is different. My plastic surgeons office told me that Medicare will not approve or disapprove reconstructive surgery. If you have a Tummy Tuck or arm lift or breast reduction, you have to be able to pay for those procedures or the ps will not do them, because after the surgeries Medicare will then decide if they are medically necessary, and if they find that they are medically necessary, they have no problem paying. But, do not say "forget it" the WLS alone with improve your life. Don't worry about the ps until that time, you may not even need any reconstructive surgery or very little. If you read the Plastic Surgery Message Board, people are always talking about ways to pay for reconstructive surgery. Start putting alittle money back now, have yard sales, take a second job or get a part time job once your weight is down and you are full of life and energy, the SS now lets you work as long as you do not make over a certain amount of money, take out a loan, borrow from a relative, but don't worry about the ps now, worry about getting yourself better. Congrats on making the decision to become healthier and extend your life! Cindy Smith Open RNY 8-6-03 -183 lbs BR 8-4-04 TT with hernia repair 2-7-05

Cindy, Thank you for responding to my question re: whether or not medicare has paid for plastic surgery after WLS. I do not have internet services so it has taken awhile for me to get over to my sisters so I could get back to you. I have been doing a lot of research re: cosmetic surgery versus reconstructive surgeryand I feel very confident that my stomach and breasts will be seen as reconstructive with Medicare. My arms and thighs can be done much later. My daughter, who will be nursing by then has offered to help with any expenses and I hopefully will be gainfully employed by then. I am just going to do one day at a time. I go for my second pysch. eval. on May 20th to see if they believe I am a good candidate for WLS or not. I didn't pass the first eval., but I think most of that was due to the psych. who conducted the eval. and not my response to the eval.. Thanks again. ShelleyR. Tha

I agree with every word Cindy said. This surgery is the key to your life and especially quality of life. Most of us, especially the older we are as obese people, are basically dead women walking by the time we get the surgery. Put the value on life extension. Right now, that's all you should be concerned with. You've got your horse tripping over your cart in a big way, as far as I'm concerned! She's also right that some of us are satisfied enough with our bodies afterwards that we wouldn't even consider all the tucks. I'm certainly no goddess in the nude, but don't look too darn bad with some clothes on. That's enough for me. Maybe you'll have more hanging skin than I do or simply be one of those women who has a higher standard for what an acceptable body is. But just worry about getting your health back first and then move on to that issue if you must. As far as the medical necessity goes, after the surgery you would need to bee-line it to the doctor's office whenever you get a rash that might be caused by the hanging skin - just to document it. Now, I certainly wouldn't do it in a million years, but I've actually heard of people manufacturing a rash when they felt their insurance wasn't gonna pay. Ick. Good luck with going for the surgery. You'll be amazed at how good the new you feels, whether you're impressed with the look or not! - Stephanie J

Dear Stephanie, Thanks for your response to my question. I have done some research on cosmetic versus reconstructive surgeries and I feel pretty confident that my stomach and breasts will be covered by Medicare or whatever insurance I may be on at the time. These areas are my main concern. You are right, now is the time to just focus on the WLS itself and so that is what I am going to do. I go in for a second psych. eval. on May 20th. I didn't pass the first one, but I think this was because of the psych. who did the eval. and not my response to the eval. Anyway, wish me luck and thanks again for the encouragement. I needed it! Thanks again. Shelley Reed

I believe that Stephanie is correct, the medical necessity comes from the skin breakdown associated with a rash from skin folds. Be sure the doc documents SKIN BREAKDOWN!. Bonnie