medicare/medicaid and tummy tuck

Lady T.
on 3/9/04 9:26 am - Silverdale, WA
I have been told all kinds of things about the tummy tuck and coverage by medicare/medicaid. Has anyone had their skin removed and had medicare/medicaid cover it? What about a breast reduction (skin removal) for the same health reasons as the tummy tuck? One thing I was told was that if it was proven as medically necessary then it would be covered. Would that include constant back and hip pain (to the point that I'm taking muscle relaxers like candy), and my Chiropractor says there's not much more he can do for me until after the skin comes off. Thanks for the input. LadyT
Roberta A.
on 3/16/04 9:38 am - Marietta, GA
RNY on 05/12/03 with
You need to have a letter of medical necessity from an orthopoedist, or at least your pcp. Who is giving you the muscle relaxers? Unfortunately, a chiropractors word is worth much for this kind of surgery. Are you having any other problems from the excess skin like rashes, sores or odors? Your pcp should document that too. What about your ability to properly exercise? Does the skin get in the way? You need to build a strong case for approval, by getting all of your ducks in a row. Good luck to you! Roberta
Lady T.
on 3/23/04 10:10 am - Silverdale, WA
Thanks for your input Roberta! My PCP told me the muscle relaxers will help 'some' with the pain in my back/hips. But it doesn't... it just makes me sleep all the time or walk around like a zombie. My PCP did give me a referral for tummy tuck/breast lift but I had to find my own plastic surgeon who would take Medicare/Medicaid on my own. If anyone else is interested in this info, the Virgina Mason Medical Center has a plastic surgery 'clinic' (I guess that's what it's called) and they do accept Medicare/Medicaid as long as you have a referral from your doctor. Their website (for contact info) is: www.vmmc.org. How do I document my inability to move/exercise properly? And when I do get the rashes under my breasts/belly apron and in my belly button, I can't get in to see my doctor usually until after the rash is already gone. But since I already have the referral, do I still need to document all this? The referral states that I should have the TT/breast reduction because of severe back/hip muscle pains, spinal displacement, and hip joint swelling (among other things)... is that enough? I'll be seeing the plastic surgeon on May 4. WOOO HOOO! Thanks!!! LadyT