Question:
Will medicare pay for a tummy tuck, arm lift or other procedures

I live in NC and am wondering if Medicare will pay for a tummy tuck and/or a arm lift. Does anyone know if you would have to pay up front before they pay. If anyone knows of anyone near Wilmington NC or Myrtle Beach SC that will accept Medicare for the procedure, and if not does anyone know the average cost for these procedures and what qualifications you need, such as rashes, etc. Thanks so much in advace.    — tatterpuddin (posted on October 20, 2006)

October 20, 2006
Sherry I too have medicare, the new 2007 manuel arrived yesterday and I looked it you, tummy tucks are considered cosmetic & not covered. I'm wondering though it it could be gotten around with documentation in the nskins problems it creating....... I'm one week out so expect to be looking inot this myself next year. Connie
   — Connie H.

October 21, 2006
I used to work in billing for Medicare for about 12 yrs...If you can get yr dr to give a medical necessity for this proceedure, yes medicare will pay for it, BUT yr dr has to PROVE (with documentation) as to why this is needed. IE, rashes, sores etc..something that can only be corrected with that proceedure...
   — crystalsno

October 22, 2006
I have medicare and they do not precertify anything. Your doctor when you go to the consult which medicare will pay 100% for and the dr puts the right codes on the paper work medicare will pay for abdominoplasty/panniculectomy-removal of excess skin on the panni and arm excess skin but will not pay for breast implants but reconstruction of breasts if removed. I have had 2 consults but each dr wanted me to pay up front ($5680 and $2500 for hospital and dr fees) and medicare pay me back due to it takes medicare so long to pay and if the drs put the right codes on the right forms when they submit paperwork to medicare. I need 6 inches of panni removed and dr approved me and I also called medicare and they gave me the right codes to give to the drs scheduling department but they still wanted me to pay and wait for medicare to pay me. I will be forever trying to come up with that kind of money on a fixed inxome with a life long disability.
   — mspisces

October 23, 2006
I had gastric bypass, a tummy tuck and a breast reduction all covered by my insurance. I have medicare and blue cross. The thing is, if the doctor can prove (in which he will) that your excess skin posses a threat to your health then they will see it as a health risk. For example, a friend of mine who also got a tummy tuck done by medicare, her stomach hung so low and it put strain on her back, not only that, some of the skin was literally dead! It was all purple and blue. And what doctors don't tell you that if you have a baby or have that pouch hanging over there is no exersice in the world that can lift it, it's just dead skin. The only way to remove it is to get it cut off. Now in your situtation in which I don't know, most doctors will see if you have a hernia, perform the tummytuck and say it was a hernia repair.
   — saraj