MEDICAID TUMMY TUCK

sspain04
on 4/11/06 6:48 am - NC
I am wondering what I need to do to start the process in trying to get medicaid to approve a tummy tuck for me. However, I do not have any sores. What other problems does anyone know of that would make it medically neccessary for one so they would pay? Any imput would be very helpful. Thanks everyone!!!
Phenomenal Woman
on 4/11/06 9:58 am - Eastern, NC
I am not sure about a tummy tuck but they will pay for a panniculectomy which is the removal of excessive skin, subcutaneous tissue, and fat of the addomen. It is covered if you are 19 years of age or older and has a BMI of 40 or above and, due to the pannus, has uncontrollable infections or medical complications, e.g. hernia, or has had gastric bypass or gastric stapling with subsequent weight loss and the resulting pannus significantly interferes with mobility or is the site of uncontrollable inflammation and or infection or other wise complications medical conditions eg hernia. This comes straight from the DMA policy and procedure from the web site Phenom
sspain04
on 4/11/06 10:31 am - NC
Thanks for the info!! I guess I am going to make an appt with my PCP and see what he thinks. I have still had problems with my back even though I have lost 159 pounds and he has known that so I am going to see if that could be affected by the excess skin. Good luck with your surgery!!
mms0725
on 4/11/06 1:17 pm - Tallahassee, FL
I'm not much help, but if you get anywhere - please let me know. I would love to know what needs to be documented, etc in order to get it approved. I'm going to try going that route also, but right now I don't even have a primary doctor, so that's my first step. Good luck! -Marcy
sspain04
on 4/12/06 4:07 am - NC
I definitely will let you know what happens. I am going to make an appt with my PCP in the next couple of weeks and see what he says. He is really good so I am hoping he can help me pull some strings. I don't even know if I need to talk to a plastic surgeon that accepts my insurance for a consultation or what. I know that I am ready to look into it and maybe have it done this summer if I can get approval. If not I am going to look into financing. Thanks for the info!
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