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How do I get Medicaid to pay for a breast reduction and tummy tuck?

Question posted by Sugarymama700 from Englewood

I am 5 5 1/2 37-year-old woman I weigh 192 pounds my bra size is 38G but my boobs are way bigger than that I think  maybe an M.  I have had six surgeries on my abdomen and my stomach muscles are a mess and I now have degenerative disc disease in my lower back severe pain in my neck grooves in my shoulders and my posture is out of whack.  My surgeries have been an appendectomy two C-sections gallbladder removal have my tubes tied and then I had a hysterectomy a year later.  I am desperate to get this breast reduction done it is just killing me and the tummy tuck would help my posture and my back a lot. I suffer from anxiety depression and PTSD I also am a stay at home mom of a child with sensory integration disorder and oppositional defiant disorder.  I spend all my time chasing him around and trying to keep both of us afloat this would greatly help my self-esteem.

Doctor's Response

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One thought on “How do I get Medicaid to pay for a breast reduction and tummy tuck?

  • Dear Sugarymama700,

    Thank you for your clinical
    post.  In Canada, each province has its
    own version of Medicaid or the Provincial Health Insurance Plans.  In Ontario, this is called the Ontario Health
    Insurance Plan or OHIP.  Each province
    has similar government funded sponsorship programs for medically necessary
    procedures.  To get a breast reduction
    funded under a medical health insurance program you need to ensure that you
    have symptoms that are functional and approved by the province.  For breast reduction it is generally neck,
    chest and shoulder pain from the mammary hypertrophy or enlarged breasts.  Intertrigo or inflammatory skin conditions
    under the breast may also qualify.

    Tummy tuck surgery is generally not
    covered by Ontario Health Insurance Plan as it is a cosmetic procedure to
    tighten underlying muscles, improve the belly button appearance or remove loose
    skin following weight loss, weight gain or child birth.

    It is not uncommon to get OHIP
    improved breast reduction combined with tummy tuck surgery performed within a
    hospital environment.  You may find you
    have to get an OHIP breast reduction in a hospital environment with a plastic
    surgeon who offers breast reduction surgery and a tummy tuck performed in a
    private facility.

    Best of luck.

    To find out more, please visit: https://www.spamedica.com/cosmetic-plastic-surgery-toronto/body-contouring-reshaping-toronto/tummy-tuck-toronto/

    R. Stephen Mulholland, M.D.

    Certified Plastic Surgeon

    Yorkville, Toronto

Additional Information

Breast Reconstruction (Reconstructive Mammaplasty or Postmastectomy Surgery)

Read about the procedure

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