Explantation Covered by Insurance?

I am considering having my breast implants removed and a lift performed as I have tremendous back and shoulder pain with the weight and my job as a dental hygienist. Any possibility it could be considered a reduction with a lift and insurance may cover the costs?

Doctor Answers (12)

Insurance coverage for explantation

+1

In some circumstances some insurance companies will cover the removal of ruptured implants -  either saline or silicone. Removal of intact implants is not usulally covered.  If a breast is painful and distorted due to extensive calcification around an implant (and especially around a broken implant) insurance companies will sometimes cover removal of the implants and the capsule.  In no augmentation (cosmetic)  case will the insurance company pay for a lift or for new implants.     If the implants are less than ten years of age and broken there is a possibility that the implant company will replace them ( both even if only one is broken).  Every insurance policy varies so you must check with your insurance  company.


Los Angeles Plastic Surgeon
3.5 out of 5 stars 5 reviews

Insurance does not cover explantation

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The insurance policies all say basically the same thing: that the sequelae, or consequences, of a cosmetic procedure are cosmetic in and of themselves.  As for claiming that this is a reduction plus lift, that would be insurance fraud.  All the insurance carriers require proof of the amount of gram weight resection accompanied by a pathology report so this procedure would be fee for service.  If you paid to have them put in, then you should pay to have them removed as well.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 11 reviews

Does insurance cover breast lift and breast implant removal?

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You need to look at your individual policy to see if your insurance contract has a specific exclusion for implant related issues or surgeries.  Each insurance contract can be different.

In more than ten years of experience I have not yet had an insurance company cover the cost of breast implant removal unless the original implant was placed as a reconstructive procedure and the insurance company paid to have it placed.

Richard H. Fryer, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 79 reviews

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Would insurance cover for explantation?

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I doubt that health insurance will cover for implant removal and lift.  Becasue you probably had breast augmentation for cosmetic reason, removing the implants would not be covered by insurance.  If you are planning to have your implants removed and also to have a large amount of breast tissue removed at the same time, part of procedure may be covered by insurance.  Please consult with board-certified plastic surgeons to discuss with your options and indications for surgery.

Sugene Kim, MD
Houston Plastic Surgeon
4.5 out of 5 stars 38 reviews

Implant removal

+1

It is very unlikely that your implant removal will be covered by insurance.  Most insurance companies will deem this as a cosmetic procedure given your prior history of breast augmentation.   Please visit with a board certified plastic surgeon to learn more about your options.

Dr. Basu

Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.5 out of 5 stars 117 reviews

Insurance Company Coverage for Breast Implant Removal?

+1

It would be very unusual for  an insurance company to cover breast implant removal ( or consider it a breast reduction procedure).  I would suggest in person consultation with well experienced board-certified plastic surgeons to discuss  your goals and options  available.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 718 reviews

Insurance coverage of breast implant removal possibly combined with breast lift

+1

Insurance companies are increasingly reluctant to cover breast implant removal, except when it is in the setting of post mastectomy or congenital breast reconstruction.  There are some exceptions with extremely high quality insurance plans that cover smaller family owned businesses and with some of the rapidly disappearing high quality union insurance plans.

 

Even if you fall into one of these categories, expect a long and involved process to obtain coverage.  You will almost certainly need supporting letters from your primary care doctors, physical therapists, and other professionals involved in the treatment of your back pain.  They need to explicitly state that the back pain is directly related to the mechanical effects of the implants.

 

Best of luck!

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 8 reviews

Insurance coverage for explantation

+1

You have to have a valid reason for the insurance to approve explantation, i.e medical necessary. The criteria vary with different insurance carriers. You may get the explantation approved by your insurance, but it would be hard to approve the lift/reduction.

Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 3 reviews

Insurance might cover implant removal

+1

Coverage may vary by your area and particular health plan, though our experience in Chicago is that most will indeed cover removal of breast implants. It cannot be called a breast reduction however, and a breast lift just will not get through.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 28 reviews

Explantation Covered by Insurance

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While creative, no insurance would blindly cover the surgery. Even with breast reduction the surgery must meet the requirements to the severity of the case and independent validation of the medical necessity.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 16 reviews

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.