Excess Skin & Medicaid

I was just wondering has anyone actually been approved with medicaid to have the excess skin removed and if so how hard was it to get approved?  I cant stop thinking about the skin thats going to be left after RNY.  I know its not something i can prevent from happening but I just wanna know if its actually possible for my insurance to approve the removal .  thanks

My understanding is that they will not. That they consider it cosmetic surgery and they will not pay for it at all.

Then again I have been told the will pay for panni removal if you can document medically that you have rashes, infections etc due to the hanging panni.

If you find out otherwise please post it as i'm sure a lot of us would love to get it done. I have a huge amount of hanging skin but i was 450 lbs for over twenty years. So I didn't really expect it to shrink up, tho I don't have as much as I expected.

don't know about excess skin...i am wondering that too (already have bad rashes). but, i do know they will pay for a redux. i was waiting until after i lost weight to get em reduced n lifted though.

I know PA medicaid will pay for panni removal if it is medically necessary.  other than that have not heard of any other they will pay for.

I live in MD & I just had a tummy tuck, breast lift, and thight lift....all medically necessary due to severe skin issues....all documented.....and all paid for by medical assistance.
All I can say is have you PCP document every time you have a rash....you take pix everytime you have a rash.....evbery med or cream used, document...... my approval process was easy due to all the documentation....it only took 3 days!
Good luck!

What is a panni? I had to have an emergency coleonctomy (think that's spelled correctly), but I now have what looks to be cat whisker shaped belly flap.. It isn't huge but it does cause complications for clothing, and daily activities..my surgeon did warn me that I would have a post operative hernia which I did, then it was discovered that my stomach muscles have divided by approximately 2"-3", he spent two hours sewing my muscles back together and implanting a very large, thick mesh as you could see my intestines moving along the scar tissue prior to the hernia mesh implant, .. but it did not hold so my stomach muscles are still divided.... If you have any advise on how I may obtain PA from Medicaid to have a tummy tuck and scar tissue removal, I'd be very grateful..

Thanks from NC

I had both Medicare Advantage Plan through AARP and Medicaid approval for skin reduction from my thighs.  It was *not* a lift, simply removal of excess skin.  They *will not* pay for lifts unless medically necessary.

Excision will most likely be approved if it's causing problems, like infection, rashes and skin erosion. I was getting cellulitis infections every other month once I lost weight (257 pounds). It got so bad that the last round had to use two different antibiotics to knock it down, which meant it was getting to be antibiotic resistant.  I had documentation from my doctor and myself.  Make sure you have a good detailed letter written.  In my case, my doctor had me to draft a letter, she reworked it and added dates of treatment for the infections and sent it in with her documentation.

Choose your words carefully.  Excision, which involves no cosmetic lifting, just removal of skin, is most likely to be approved, especially if it is contributing to or causing other health issues.

I've heard of some WLS patients who lucked out and got a surgeon who threw in the lift part just because.  Not likely, but worth hoping for.  Just don't get depressed if it doesn't happen.

My upper body, arms and breasts, will be on me, since they are not currently causing any medical issues. Some surgeons also have an age limit for certain procedures.

 

I actually found this site by Googling tummy tuck or skin removal with Medicaid and it brought your question up to the front of Google homepage. I went to answer you and it wouldn't let me answer you unless I was a member so I applied or subscribed and now I can talk to you about this also get good information myself as well. The biggest thing is doctors will take insurance to remove skin absolutely but the skin has to be proven to get in the way of your daily life that it is so bad or so much that you can't function on a normal level with it. Because anything other than it being done for medical reasons reason would make it a cosmetic reason and I don't think that Medicare would pay anything for cosmetic surgery.

I'm in Virginia and also have Medicaid. I'm also a Certified Professional Coder - Biller..

If you're worried about just the sagging skin. You're out of luck.

BUT, if you end up having fungal infections, yeast.. rashes..then they'll pay 100% for it.  But you MUST, MUST document your infections.. taking pictures.. going to the doctor everytime.  That's the only way they'll pay.