Plastic Surgeons Who Accept Medicaid Insurance

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Tips For Getting Covered

Breast Reduction Surgery and Health Insurance Coverage (Q& A)

If you think you may be a candidate for insurance-funded cosmetic plastic surgery, a good surgery center will work with your medical insurance to help you make a solid case.

Make it clear to your doctor and the insurance company that you have tried other measures such as weight loss, physical therapy, and pain treatment options before resorting to surgery. This will help your insurance provider see the surgery as a last resort, which will make them more likely to cover it.

Medical documentation is also a very important part of the process. Make sure you keep records stating every health change youve made as well as all the times you visited your doctor in search of a solution.

Is Breast Reduction Covered By Health Insurance

I recently saw a female college student as a new patient consultation in my office concerning possible breast reduction surgery. This procedure, also known as reduction mammaplasty, is indicated for the treatment of symptomatic macromastia . The commonly reported symptoms related to macromastia are neck, shoulder and back pain caused by the weight of overly large breasts upon the musculoskeletal system. Other secondary symptoms can include breast pain and dermatitis or rashes beneath the breasts.

The college student was referred to me by her gynecologist and arrived with a prescription recommending a consultation with a plastic surgeon due to her condition. The patient was under the common impression that because she was referred to me by another physician, that the suggested surgery would automatically be covered by her health insurance plan. She came in hoping that the breast reduction surgery could be scheduled in four weeks, during her winter break from college.

After completing a patient history and regional breast examination, my staff discussed with her what would be needed to obtain insurance authorization for her surgery.

Which Cosmetic Surgery Procedures Are Usually Covered

Here are a few common procedures that are often covered by health insurance. Its important to note that many other procedures, such as ear surgery and even teeth-straightening, may also be covered in certain circumstances.

  • Breast reduction surgery

To qualify for reduction mammoplasty, the patient and her doctor must be able to show that large breasts have hindered her ability to perform certain physical activities, or that they have subjected her to physical pain back and shoulder pain are the most common.

In order to address the physical symptoms associated with large breast size, surgery may be necessary. Just like all semi-cosmetic procedures, whether or not a reduction will be fully covered differs from company to company and plan to plan.

Breast reconstruction or a breast lift may be necessary for optimal results in addition to the reduction. In such scenarios, its common for the insurance company to pay for the reduction, but not the lift. Of course, when a patient has breast cancer, breast reduction or mastectomy surgeries are often medically necessary.

As mentioned above, if drooping eyelids hinder a patients ability to see and vision tests prove this to be the case then blepharoplasty is often medically necessary. For this reason, eyelid surgery is one of the most common cosmetic procedures to be covered by insurance.

  • Excess skin removal
  • Gender reassignment surgery

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Answer: Many Doctors Do Take Medicaid

and will do reconstructive procedures if indicated. But you are asking about a cosmetic procedure and no insurance will cover such procedures. Best to call around and find out what kind of fees you are looking at so you can prepare for this down the road. Also, newer surgeons may be more willing to negotiate fees to your advantage to help with their ‘portfolio’ of happy patients as they mature and become more experienced.

Where Can I Find A Doctor That Accepts Medicare And Medicaid

Profile

To find a doctor that accepts Medicare payments, you may want to visit the Centers for Medicare and Medicaid Services’ Physician Compare. You can search by entering a health care professionals last name or group practice name, a medical specialty, a medical condition, a body part, or an organ system. This tool will provide you with a list of professionals or group practices in the specialty and geographic area you specify, along with detailed profiles, maps and driving directions.

Please note that Physician Compare only lists professionals that accept Medicare. Although some may also accept Medicaid, it does not have information about which professionals do accept Medicaid.

Medicaid programs vary by state and each state Medicaid agency maintains their own list of professionals that accept Medicaid. For further assistance, please contact your health plan or state Medicaid agency. For more information about Medicaid, visit the Medicaid & CHIP page on Healthcare.gov.

If you have trouble accessing the Physician Compare website, please call 1-800-MEDICARE and a representative will be able to run the search for you. They can also send you a print version of the search results.

There are other directories on MedlinePlus that will help you find health professionals, services, and facilities, some of which may serve Medicare or Medicaid payments.

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What Is A Plastic Surgeon

Plastic surgeons surgically restore or repair the form or function of a particular body part . The procedures and surgeries offered by a plastic surgeon can be either cosmetic or reconstructive in nature.

Cosmetic surgery, also referred to as aesthetic surgery, is an elective surgery and is not undertaken to treat a specific medical condition or injury. Rather, it focuses on surgically improving of the visual appearance of a body part, with many patients choosing to undergo an elective cosmetic procedure to improve self-image and confidence. One example of a elective procedure is rhinoplasty surgery though it may also double as a reconstructive procedure in the event of a broken nose.

Plastic surgery also includes reconstructive procedures, performed to restore the function of a body part adversely affected by a medical condition, defect, or injury. For example, surgery to correct a cleft lip or palate are relatively common reconstructive procedures.

Free Breast Reduction Insurance Verification

We want to speak to you! Fill out the form below to schedule a free phone consultation with one of our Patient Care Coordinators. They will answer questions about the surgeries we offer and provide information about costs, financing, and health insurance. Theyll also help you schedule an appointment with one of our plastic surgeons. We are in-network with United Healthcare and Oxford, and will accept The Empire Plan , as well as Cigna, Aetna, and Blue Cross plans if you have out-of-network benefits.

According to the American Society of Plastic Surgeons: In the case of breast reduction for insurance purposes, breast reduction plastic surgery will typically be considered a cosmetic procedure until the patient can prove an adequate number of health issues and attempted remediations of those issues prior to undergoing corrective surgery. Once the threshold has been reached, the insurance company may then consider breast reduction a reconstructive procedure for that patient and cover it.

Medical Reasons for a Breast Reduction Include:

  • If your breasts are causing you neck, shoulder, or back pain, or maybe even bad posture or numbness.
  • Chronic rash or skin irritation underneath the breasts.
  • You experience breathing difficulty.

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Breast Reduction Nyc Accepted Insurance

The Breast Reduction Center of NYC, located on the Upper East Side in Manhattan, New York offers free breast reduction plastic surgery insurance verification and breast reduction surgery consultations. Though the Breast Reduction Center of NYC accepts most medical insurance for breast reduction plastic surgery the insurance coverage and the amount of insurance coverage will depend on your specific medical insurance coverage. Breast reduction plastic surgery falls into the medical insurance category of reconstructive plastic surgery and may be covered by your medical health insurance.

Dr Blechman has surpassed every expectation that I had for a plastic surgeon and for my breast reduction surgery. He is extremely pleasant and caring and goes above and beyond to ensure his patients are taken care of. He is always available and no concern is to small to get his immediate attention. He is honest about results and expectation and does a great job at addressing all concerns and questions. If I could give him 10 stars I would but 5 stars will just have to do. I am extremely happy with my decision to choose him for my breast reduction surgery, my results are phenomenal and he will definitely be my choice for any other future surgery. ~ Google

Nc Medicaid Managed Care Mandatory

Why Plastic Surgery Is On The Rise

To learn more about NC Medicaid Managed Care, go to the NC Medicaid Managed Care Website. Most beneficiaries receiving Medicaid or NC Health Choice will be required to transition to NC Medicaid Managed Care. This means you must choose a health plan and a Primary Care Provider . If you must choose, NCDHHS – Division of Health Benefits will send you a letter that tells you how to transition to Managed Care. You will be required to transition to NC Medicaid Managed Care if you:

  • Receive full benefits through the Family and Childrens or the Aged, Blind and Disabled Medicaid programs, or through the NC Health Choice or Medicaid for Pregnant Women program.

If you are transitioning to NC Medicaid Managed Care and want to keep the PCP you have now:

  • Choose a health plan that your provider works with. If you have questions about the instructions in the letter you received ,

To find a doctor, go to Find a provider.

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Can I Get A Breast Reduction With Medicaid

I was given a referral for a reduction but the doctor left. Im looking for a breast reduction doctor in NYC that accepts Medicaid but it is managed by Fidelis. I have 34E breast, I believe it might be bigger for it keeps growing. I cant take the pain on my back and neck and Im also sure it is starting to affect my breathing for I suffer from asthma. I come from a family from big breasted women, my mom had a reduction at 21 years old.

Answer: Breast Reduction And Insurance Approval

Insurance coverage is dependent upon documentation of the medical necessity of the procedure. This typically includes musculoskeletal pain, rashes, and bra strap grooving. Patients must also demonstrate a resistance to or failure of more conservative measures including weight loss, physical therapy, and medical therapy. Finally, there will often be requirements for minimum resection. Based on your stories and photos, you would seem to be a reasonable candidate for surgery. However, documentation is the name of the game if you are seeking insurance approval.As always, discuss your concerns with a board certified plastic surgeon .

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Dr Comizio: Your Breast Reduction Advocate In New Jersey

Breast reduction insurance can be a tricky and exhausting process. But our patients absolutely love how bold and assertive Dr. Comizio is on their behalf. Breast reduction is one of the procedures that Dr. Comizio has studied and researched most during her Ivy League education. She has written numerous scholarly articles on breast reduction and continues to give lectures and speeches about it at conferences. Because patients experience some incredible benefits and relief from breast reduction, Dr. Comizio always does her best to get her patients coverage.

Dr. Comizio is in-network with many of the major health insurance providers and has a great deal of experience working with all of them. Plus, as an in-network doctor, many of our New Jersey patients meet their deductible/coinsurance requirement and have no further out of pocket expenses after that.

Costs Connected With Cosmetic Surgery Are Not Covered

Cosmetology Medical Operation Stock Photo
  • Costs Connected with Cosmetic Surgery Are Not Covered
  • Date Issued: 3/27/2015

    The Centers for Medicare and Medicaid Services recently changed their guidelines for cosmetic procedures to include any services related to a noncovered cosmetic procedure. EmblemHealth is complying with the CMS guidelines and instituting them across all of our networks and plans. Our policy on cosmetic surgery is that EmblemHealth does not cover cosmetic procedures under the following circumstances:

  • When the procedure is performed solely for psychological reasons.
  • In the absence of documentation that substantiates the procedure is being performed to restore or improve bodily function or is medically necessary.
  • Ancillary services related to cosmetic procedures are not considered medically necessary and are also not covered.

    All cosmetic surgery requires prior approval. You may view EmblemHealths medical policy on cosmetic surgery in the Medical Policies section of our website.

    Cosmetic Surgery Procedures

    For additional information you may review the CMS guidelines on cosmetic surgery at the CMS website.

    CMS Medicare Benefit Policy Manual

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    How Can I Book An Appointment Online With A Medicaid Plastic Surgeon In Lexington

    Zocdoc is a free online service that helps patients find Medicaid Plastic Surgeons in Lexington and book appointments instantly. You can search for Medicaid Plastic Surgeons in Lexington by symptom or visit reason. Based on that information, youll see a list of providers who meet your search criteria, along with their available appointment slots.

    Is There A Doctor In Alabama That Will Accept Medicaid

    Hello, Im a 30 year old mother. My primary doctor and i have been trying to find someone in our area that will accept medicaid and also do my breast reduction. my breast are overly large and are very heavy, i suffer from really bad back an neck pain and also my bra straps make a very bad indention on my shoulder. I would really like for some one to do my surgery. This would really make a big difference in my pain that I do have. So if anyone will please help me I will be willing to travel.

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    Answer: Is Breast Reduction Covered By Medicaid

    Insurance coverage is available for procedures considered medically necessary. They want to know that your condition is having or may have a negative affect on your health . Most women with large breast have problems with neck, back, shoulder pain , bra strap grooving, skin irritation, and so on. All of these issues are probably very well known to you. In most cases insurance companies, including medicaid, want to know that you have tried more conservative treatment to alleviate your symptoms. Did you lose weight, do you excercise to strengthen your back muscles, do you use appropriate support bras, are you using powders and creams to treat skin issues?If these treatments have failed, and it has been documented appropriately by your family physician or internist, then your insurance/ medicaid should cover the procedure. First you should see your doctor. He/she will offer conservative treatment options. They will then refer you to a plastic surgeon who is a medicaid provider. You will see that board certified plastic surgeon who will them submit a request for authorization to medicaid. I hope this helps. Best Wishes

    Breast Reduction For Women

    Medicare vs. Medicaid | Mnemonic for USMLE

    Breast reduction surgery, or mammoplasty, is the removal of excess fat, tissue and skin to create breasts proportional to your size. In most cases, excessively large breasts can cause discomfort and skin irritation, as well as emotional and physical pain.

    Breast reduction is most effective after your breasts are fully developed. Pregnancy and weight gain or loss can cause changes to your breasts, which may affect previous breast reduction surgery. Additionally, reduction surgery may cause limitations if you are planning to breastfeed in the future.

    Discuss with your breast reduction surgeon any questions or concerns you may have prior to surgery. At Henry Ford, our cosmetic experts are highly trained and use the most advanced surgical techniques to help you look and feel your best.

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    How Can I Book An Appointment Online With A Medicaid Plastic Surgeon

    Zocdoc is a free online service that helps patients find Medicaid Plastic Surgeons and book appointments instantly. You can search for Medicaid Plastic Surgeons by symptom or visit reason. Then, choose your location. Based on that information, youll see a list of providers who meet your search criteria, along with their available appointment slots.

    What Is Breast Reduction Surgery

    Breast reduction surgery is another name for a procedure called reduction mammoplasty. During the procedure, surgeons remove excess fat and tissue from the breasts to reduce their size and weight. Breast reduction surgery can help relieve back pain, chafing or rash under the breasts and neck strain. It may also alleviate any psychological symptoms associated with having large breasts.

    Although many women choose to have breast reduction surgery to relieve troublesome health symptoms, the surgery is sometimes performed for cosmetic purposes.

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    Liposuction For The Treatment Of Lipedema

    Lipedema is a painful disorder in women characterized by abnormal deposition of adipose tissue in the lower extremities leading to circumferential bilateral lower extremity enlargement typically seen extending from the hips to the ankles resulting in edema, pain and bruising with secondary lymphedema and fibrosis during later stages. The pathogenesis is unknown and no curative treatment is available. Conservative therapy consisting of lymphatic drainage and compression stockings is often recommended, but is only effective against the edema. Some patients showed a short-term improvement when treated in this way. Combined decongestive therapy is the standard of care in most countries. Since the introduction of tumescent technique, liposuction has been used as a surgical therapeutic option.

    Peled and co-workers stated that diagnosis of lipedema is often challenging, and patients frequently undergo a variety of unsuccessful therapies before receiving the proper diagnosis and appropriate management. Patients may experience pain and aching in the lower extremity in addition to distress from the cosmetic appearance of their legs and the resistance of the fatty changes to diet and exercise. These researchers reported a case of a patient with lipedema who was treated with suction-assisted lipectomy and use of compression garments, with successful treatment of the lipodystrophy and maintenance of improved aesthetic results at 4-year post-operative follow-up.

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