Would my Insurance Pay for Breast Surgery?

I am 5' 4", 22 years old, and 135lbs. I have two seperate breasted sizes. One is a 36C almost a 38C and my other breasted is about a 32A or 36A. Having two different sizes does make my self confidence go down a lot. I cant wear any kind of bathing suits besides one pieces and bondous styles so I can insert two lifting pads into my top. I cant wear certain tops because of how you can definetely tell a difference. The size difference didn't start until I was 16 when I was in weight lifting class.

Doctor Answers (13)

Insurance coverage for breast asymmetry

+2

Though correction of significant breast asymmetry is well worth repair, medical insurance does not recognise asymmetry as something that is medically necessary to correct. Medical insurance is trending to more and more restrictive coverage, what we call 'life or limb'. It might be worth a letter to determine coverage or a review of your plan, though we would not be hopeful.


Chicago Plastic Surgeon
4.0 out of 5 stars 28 reviews

Breast Surgery and Insurance

+2

Hello Katherine,

 

A Board Certified Plastic Surgeon who is contracted with insurance companies will be able to assist you with your question. We are contracted with several major providers so we have knowledge of your question.

It is my experience that you will need to have a history of problems associated with your breast size well documented before you go see the surgeon. If you are a candidate for insurance coverage, they, not the surgeon and you, will dictate how much tissue has to be removed from each breast (the same amount must be removed from each breast). The amount that has to be removed is also a consideration when electing insurance coverage as most patients have an idea as to what they want their breasts to look like!.

In almost all cases, the amount an insurance company will pay is in part, not in full. The best of luck to you, I hope this helps!

Marshall T. Partington, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 62 reviews

Insurance coverage for breast asymmetry

+2
Unfortunately, insurance companies consider correction of developmental mammary asymmetry to be cosmetic based on criteria related to lack of functional medical necessity. Correction of breast asymmetry is certainly a worthwhile procedure and I would recommend that you consider it and ascertain whether the cost is something that you can afford now or in the future. Best wishes.

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

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Cosmetic Breast Surgery: The, Role of Insurance

+2

Insurance companies are quite restrictive in the procedures they cover.   If a patient meets very strict criteria, breast reduction may be covered.   By law, breast reconstruction following breast cancer is covered.   Unfortunately, breast asymmetry is rarely covered.  This is unfortunate, but insurance companies require medical necessity to provide coverage, and they are not too concerned how a person looks or feels.   What a bummer!

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 17 reviews

Insurance Unlikely to pay... :(

+2

Katharine:

I am sorry to say that most insurance companies will not pay for this type of surgery anymore. It's not impossible, but it is difficult to get them to comply.

 

It may be worth a shot if its your only option.

 

best wishes,

 

Dr. Michael in Miami

Michael Salzhauer, MD
Miami Plastic Surgeon
5.0 out of 5 stars 259 reviews

Would my Insurance Pay for Breast Surgery?

+2

It is not common for an insurance carrier to pay for what they consider cosmetic breast surgery, but it is not unheard of either given the circumstance. Your insurer might be able to answer your question over the phone, but the insurer might ask questions that you might be unprepared to answer, such as diagnostic and procedure codes. 

Seeing a plastic surgeon who can help you sort through the surgical options is a good start. That surgeon can initiate an authorization process with the insurer. I can only caution against too much expectation here.

Thanks for your question, best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 31 reviews

Insurance rarely covers breast augmentation

+2

Breast asymmetry is present in everyone to some degree. The degree of asymmetry however can be very minor and barely noticeable, or very significant- as in your case.  Since you have such a large size disparity between your breasts, it may be worth while to call your insurance provider and ask for a determinaiton of benefits. I would recommend tempered expectations since typically, insurance providers do nocover breast augmentation surgery, but it's worth the phone call.

Lawrence Iteld, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 20 reviews

Insurance Coverage for Surgery for Breast Asymmetry?

+2

Sorry to hear about the “self-confidence” issues that have arisen because of the breast asymmetry.  It is possible, but probably unlikely,  that a health insurance company will provide coverage for surgical “reconstruction”. The only way to know for sure is to call the health insurance company and see what your policy allows for.

 When the time is right, seek consultation with board-certified plastic surgeons. Ask to see  also examples of his/her work,  of the patients in your situation.   Communicate  your goals clearly ( I prefer the use of goal pictures in my practice).

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 715 reviews

Breast asymmetry and insurance.

+2

Congenital breast asymmetry may be covered by your insurance company. I recommend calling your insurance company to find out your exact coverage options. A consultation with a plastic surgeon and a letter from both your primary care physician as well as your plastic surgeon may convince the insurance company to cover some or all of the costs.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 12 reviews

Breast Enhancement

+1
Typically aesthetic surgery even corrective surgery of asymmetries is not covered by medical insurance companies because asymmetries are normal

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
5.0 out of 5 stars 36 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.