Complications Post Op BR W/O Insurance- Am I Responsible?

If my insurance does not agree to pay for my surgery and I end up having horrific complications (that require hospitalization) am I going to be responsible for those bills?

Doctor Answers (11)

Complications postop BR w/o insurance - am I responsible?

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Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.  Depending on the complication and need for hospitalization, it may be covered.  You should discuss exact details with your insurance. 

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!


Scottsdale Plastic Surgeon
5.0 out of 5 stars 11 reviews

Health insurance and cosmetic surgery

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Everyone's health insurance policy is different, however, in general, most health insurance plans do not cover any complications resulting from a cosmetic procedure. You have to read the fine print of your individual plan. However, there are very reasonable priced cosmetic insurance plans that can be purchased prior to your cosmetic procedure that cover complications resulting from the cosmetic procedure. Your plastic surgeon can give you information on these plans that are sold by a separate company. You can also ask your plastic surgeon if you are at increased risk of having a complication and thus worth the extra expense of obtaining the policy.
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 26 reviews

Find out pre-op if insurance will cover cost of postop complication

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Hi TallOne,

This is an excellent question. Unfortunately, you must contact your insurance company to find out the answer.  In my experience, if a patient has a post-operative complication that requires, for example hospitalization, the patient's insurance will cover this cost.  This is true even if the complication is related to elective, cosmetic surgery that the insurance did not pay for.  Fortunately, these events are very rare but it could happen and it is best to know ahead of time what your policy will cover.  As you can tell from the answers from the other plastic surgeons, insurance does not always cover these costs; I suspect it varies by state.  For minor problems that can be handled in the office, we do not charge for this as it is considered part of the post-operative care that is included in the surgical fee.  I suggest you contact your insurance company and ask them this question.  In our office we have an insurance consultant who does this for the patient and your plastic surgeon may offer this service as well.  Finally, be sure and discuss with your plastic surgeon pre-op how they handle fees for revisions, etc.  Hope this helps.

Tracy M. Pfeifer, MD, MS

 

Tracy Pfeifer, MD
Manhattan Plastic Surgeon
5.0 out of 5 stars 17 reviews

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Most insurance contracts have exclusions for both aesthetic surgery and complications following aesthetic surgery.  This is definitely something to discuss pre-operatively with your surgeon.  Some plastic surgeons offer a relatively low cost policy which covers these rare, but potentially expensive, post-op problems.

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Har dot say whether your insurance company will cover complications of surgery. That is something to check out with your insurance.

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Your questions is both an excellent one and a fairly common one with regard to non-insurance covered breast reduction surgery. Fortunately, such complications are rare but there is always that Murphy's Law. There can be minor issues that can occur and which should be easily addressed in an office setting. This is something that you will need to discuss with your plastic surgeon.

You need to contact your insurance company and find out exactly what their policy is regarding coverage of complications from a procedure that they are not paying for. 

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Complications Post Op BR W/O Insurance- Am I Responsible?

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Tough question. In most states and with most health insurance plans complications after a surgery are a covered benefit. But if your health plan would not cover a breast reduction you might have a very very restricted plan with deniable benefits outlined in the plan's paperwork. Check it out yourself. 

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If your insurance company agrees to cover the breast reduction surgery, it will also cover the treatment of postop complications.  If you are paying for the surgery out of pocket, your plastic surgeon should provide you with a written explanation of his financial policies and responsibility for secondary surgery.  My policy is that, for issues brought to my attention in the 6 months after surgery, I do not charge a fee for revision but the patient would be responsible for any necessary facility or anesthesia fees.  This is quite standard.  That said, breast reduction has the highest patient satisfaction rate of any procedure I perform.  Certainly, if you pay for any operation out of pocket, it is important to know what your financial responsibility would be thereafter. 

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Cost of Non-Insured Breast Reduction Complications

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Your insurance coverage is really a legal contract between you and the carrier so you would need to get clarification from your carrier. Fortunately, breast reduction is one of those operations that seems to provide huge benefits with a low risk. We do our reductions in our private surgical center so that if a patient does have a problem we are able to take care of it here and not in a hospital with their very high costs. You might check for a similar situation near your hometown.

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Insurance for breast reduction complications

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Your insurance may cover any care that is of 'medical necessity' and this would include things that could happen after breast reduction such as bleeding, or an infection that follows breast reduction. You can contact your carrier to confirm. Some policies restrict coverage for problems related to breast implants, though again your insurance plan is unique and a call can settle the issue.

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.