Does Medicaid Cover Liposuction – Overview?
Medicaid usually covers surgeries for life-threatening injuries or illnesses. These may include open-heart surgeries or surgeries to remove malignant cancerous tumors.
However, many people ask if Medicaid covers liposuction as it is an elective cosmetic procedure most of the time. The answer is that it depends as many such surgeries fall into a gray area.
Hence, it is highly advisable to consult with a representative from your Medicaid insurance carrier in such situations.
The approval to bear the cost by the company usually depends on three questions:
#1. Is the surgery medically necessary?
#2. Is surgery the least costly alternative?
#3. Does your state have special rules?
What is Liposuction?
Liposuction is a surgical treatment. This procedure is also called lipoplasty or body contouring. It uses a suction technique to remove fat from certain areas of the body.
This includes removing fat from the hips, buttocks, abdomen, neck and arms.
This is a minimally invasive surgical procedure. It is often ranked as an aesthetic procedure but may be termed as medically necessary in some situations.
Liposuction also helps to contour (shape) these areas of the body to look healthier and more attractive.
However, this procedure is not usually recommended as a weight-loss procedure or alternative.
If you are overweight and want to lose weight, then dieting and exercising or bariatric procedures may be better alternatives for you.
If you have excessive body fat accumulated in one place, you may be considered a candidate for the liposuction procedure.
However, you should be committed to taking aftercare precautions to ensure optimal successful results from liposuction.
Does Medicaid Pay for Liposuction?
Medicaid does not usually pay for liposuction. This is because targeted fat reduction normally falls under cosmetic elective surgery.
Even if your body shape does not improve after dieting and exercise, it may not be considered to be medically necessary.
How to Get Cover for Liposuction?
However, you can still get Medicaid coverage for liposuction if your doctor can prove that the procedure is medically necessary.
This is usually the case when you need to undergo liposuction to treat an underlying medical condition. Some of these situations include getting treatment for:
#1. Lipomas – These are benign fatty tumors that need to be removed using liposuction.
#2. Gynecomastia – Liposuction can efficiently remove the extra fat from around the chest area.
#3. Lipodystrophy – This condition causes the selective absence of adipose tissues.
#4. Axillary hyperhidrosis – This condition causes excessive sweating in the armpits.
Your doctor will have to prove that you need to undergo the procedure to correct one of the above-mentioned conditions.
Then Medicaid may cover the cost of liposuction surgery by considering it medically necessary.
Alternatively, Medicaid may cover liposuction costs when a weight loss surgery requires it. However, there are strict criteria regulating this.
To get Medicaid cover for liposuction for weight loss purposes, you need to fulfill the following conditions:
#1. Being older than 15 (male) and 13 (female)
#2. Having BMI (body mass index) of over 35 with at least one comorbidity
#3. Being under 21 years and having BMI over 40 with at least one comorbidity
#4. Bearing a letter from your primary physician advising that weight loss surgery is medically necessary
#5. Passing a psychological examination
#6. Presenting documents to prove that you attempted to treat comorbidities using conventional treatments but with no acceptable results
#7. Presenting documents to prove that you participated in a medically supervised weight loss program for 6 months, within 12 months from the surgery
#8. Being ready to make changes to diet and lifestyle after weight loss surgery
#9. The physician is ready to offer nutritional and psychological services before and after the weight loss surgery
Medicaid, just like Medicare, does not cover the cost of cosmetic procedures. This includes body contouring procedures involving liposuction.
However, if you can prove that the liposuction procedure is part of a larger treatment program, then you may qualify for Medicaid coverage for liposuction.
To enjoy Medicaid benefits, you should consult with your physician and local Medicaid representative before applying for insurance coverage.