Breast Implant Revision: Q&A

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Partial Insurance Coverage for Augmentation Problem?

Bi-lateral augmentation (hopefully surgeon was honest when he said they were saline,) 2/1982. They seemed to hold up well and I am now 57. Took a hard fall onto brick patio 4 mos. ago; CT for atlectasis/pneumonia showed "likely rupture" of R' implant. Both are likley ruptured as the last mammogram shows folds in each one. Will insurance cover the removal if done in outpatient hospital setting? No guarantees I know; but am hopeful and wonder how to approach BCBS. Thanks so much!

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10 Doctor Answers | Asked by Queenie1953 in Panama City

Doctor Answers (10)
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Breast Implant Revision - Insurance Coverage

Hi Queenie1953 The absolute answer to any question concerning insurance coverage for this, or any other procedure, is that it depends on the specifics of your insurance policy. Each policy is different and there's no way to determine that in the abstract. What you'll have to do is to go to a plastic surgeon, explain what the situation is, collect any outside reports of consultations and non-interventiional diagnostic tests you've had, and then have your plastic... more

Breast Implant Removal and Inusrance

The only way to know if the removal of your deflated implants would be covered is is to contact your insurance provider and discuss your specific situation. Every Insurance company and every plan is different. Best wishes!

Insurance coverage

The only breast surgery that insurance companies will cover are related to procedures for reconstruction after breast cancer. Given your prior history of cosmetic breast augmentation, it is very very unlikely your insurance company will provide coverage for your implant removal. But you can always call your carrier to find out...

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Coverage by insurance

Each insurance coverage is different in the way they handle patients with implants. You should contact your insurance company and ask them.

Steven Wallach, MD

13 reviews

Manhattan Plastic Surgeon

Implants problems covered by insurance

The answer to this question is "sometimes." Capsular contracture and implant rupture are the most common reasons for insurance to cover breast implant problems. However, every plan is different and it also depends on whether or not your surgeon is in network or out of network. This is worth a call to the office of your surgeon for guidance.

Jay Calvert, MD

20 reviews

Beverly Hills Plastic Surgeon

Insurance Coverage of BreasT Implant Removal

Insurance plans are not an all-you-can-eat menu; they are better described as a cafeteria dining where you pick the dishes you want (the services covered), you pay (your employer) pays for them and you get to eat (or get to be treated for) what you paid for. If YOUR policy does not cover medical services you may need or want, they are not obligated to pay for them. When it comes to breast implants, the operation was cosmetic (IE not intended to save life or improve function) and as... more

Peter A. Aldea, MD

35 reviews

Memphis Plastic Surgeon

Insurance Coverage of Implant Replacement

The only occasion in which insurance will definitely cover the replacement of a ruptured implant is wheb the diagnosis of breast cancer is present. Rarely insurance companies will cover removal, but not replacement, of silicone implants which were placed for cosmetic reasons and are ruptured.

Insurance coverage for possible implant rupture?

If you had saline implants placed diagnosis of a rupture is usually fairly easy as there would be a drastic change in volume. For silicone, this is not the case. Regarding your question about insurance coverage for a possible rupture of breast implants placed for cosmetic reasons, this does vary quite widely among insurance companies. In some situations, a few may paritally cover this particularly if there was an associated capsular contracture or clear cut evidence of trauma. To... more

Breast Implant Removal

Sometimes breast implant REMOVAL can be covered by insurance. Often, however, they will request documentation that shows the implant or breast capsule (normal scar tissue that forms around an implant) is causing pain or irritation from contracture. A physical exam may help in this. They do not often cover implant removal just for rupture.

William A. Wallace, MD, FACS

11 reviews

Jacksonville Plastic Surgeon

Insurance coverage

I think it's pretty unlikely that insurance will cover any part of your surgery. They will sometimes cover removal of ruptured of silicone implants or in the case of painful capsular contracture. The best thing you could do is to have your surgeon try to get a preauthorization from your insurance company and see what they say. Best of luck!

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Breast Implant Revision: Q&A

Partial Insurance Coverage for Augmentation Problem?