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Excess Skin & Medicaid

Kimberly129
on 9/11/10 6:22 pm - Austin, TX
RNY on 12/02/10 with
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
HW389 SW367 CW273 GW180 
1lb lost is 1 step closer to your g
oal !!
    
littleskie
on 9/11/10 7:27 pm - freeport, TX
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.
            


Met my first goal, met my second goal, met my surgeons goal. Now I have a new goal!
    
shellydean1
on 9/11/10 8:47 pm
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.
Shelly

Slowly and surely, I am learning.
 

        
dommiepa
on 9/12/10 6:58 am - Towanda, PA
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.

Yvonne.    To thine own self be true.     hw 432/ sw 352/ cw196.8/gw 200  RNY 8/11/10 Corsettrunkplasty & thigh lipo 5/16/2012.

                

HEATHER J.
on 9/12/10 7:01 am - Church Hill, MD
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!


Starting weight 301 Current weight 127


No Matter How I May Change, I Will Still Be ME!!!!

JazzyOne9254
on 8/14/14 1:03 pm, edited 8/14/14 1:04 pm

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.

 

HW 405/SW 397/CW 161.8/GW 160
The DS is *THE*  solution to Severe Morbid Obesity! Check the stats!

mommy2chloe
on 9/12/10 9:42 am - Charlottesville, VA
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.