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When Will Health Insurance Pay for Implants?

asked 1 year ago by always curious in Milwaukee, WI
Latest answer by Steven Wallach, MD
Question viewed 456 times
Tags: fibroadenomas, insurance

I have small breasts (barely A) and many fibroadenomas in one of them that are growing and I keep finding more. I will need to have them removed at some point and I'm wondering if, because it is a medical necessity, my health insurance will pay for me to get implants afterwards, as I will likely end up with almost no breast on one side.

12 answers to When Will Health Insurance Pay for Implants?

Breast implant coverage

If you have mastectomies for prophylaxis you are a candidate for reconstruction and your insurance company should cover that.

Steven Wallach, MD
Manhattan Plastic Surgeon

Insurance coverage of breast implants

Health insurance companies usually only cover medical and surgical procedures which they deem to be "medically necessary". It is very unlikely that an insurance company will cover breast implants except in cases of reconstruction after cancer surgery. However, your surgeon may request pre-determination prior to your surgery by submitting the required documentation to the insurance company.

Olivia Hutchinson, MD
New York Plastic Surgeon

Insurance Coverage

Breast Implants are covered if they are being used as part of a reconstruction after breast cancer or mastectomy. Insurance companies generally do not cover other procedure as they deem them cosmetic surgery.

C. Bob Basu, MD
Houston Plastic Surgeon

www.basuplasticsurgery.com

When Will Health Insurance Pay for Implants?

You nee to write/call/ fax your insurance company to see if the certification/qualifications/predeterminations are or include implants for fibroadenoma removal. Also have a boarded PS write a letter for you. It just may help but I doubt it. But worth the try. From MIAMI DR. Darryl J. Blinski

Darryl J. Blinski, MD
Miami Plastic Surgeon

$ave Your Money

It is difficult to predict how your insurance company will decide in this matter. It depends in large part on how your breasts look after the removal of the fibroadenomas. If there is a great deal of difference between the two sides, the chance of insurance coverage is greater. Coverage of breast augmentation also will depend on what the state of health care is in our country when you try to have your surgery. My best advice: Save your money to pay for breast augmentation yourself. more

George Sanders, MD
Los Angeles Plastic Surgeon

Submit insurance letter with supporting photographs documenting deformity

It is most probable that implants will NOT be covered for benign disease. However, if you have a compelling story and dramatic differences, consider having your general surgeon compose a letter with supporting photographs requesting a predetermination of benefits. Perhaps the reviewer would be sympathetic to your cause (unlikely) but it may be worth a chance if the difference is as pronounced as you state.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Breast implants

Breast implants are covered by insurance mainly in the case of breast reconstruction in cases of breast cancer.

Shahin Javaheri, MD
San Francisco Plastic Surgeon

Breast implants are covered for breast reconstruction and?

Breast implant are covered by insurance for breast reconstruction, but also depending on the policy and review, implant may also be allowed for cases where 'medical necessity' has been established. We have had implant coverage in young women with developmental asymmetry including Polands's syndrome, and for rehabilitation after multiple breast biopsies and for individuals who have a simple mastectomy because they are breast cancer gene carriers. It never hurts to begin with a... more

Peter E. Johnson, MD
Chicago Plastic Surgeon

www.peterejohnsonmd.com

When Will Health Insurance Pay for Breast Implants?

Regarding: "When Will Health Insurance Pay for Implants? I have small breasts (barely A) and many fibroadenomas in one of them that are growing and I keep finding more. I will need to have them removed at some point and I'm wondering if, because it is a medical necessity, my health insurance will pay for me to get implants afterwards, as I will likely end up with almost no breast on one side." Your situation MAY be an exception (read further) but in general insurance... more

Peter A. Aldea, MD
Memphis Plastic Surgeon

"Medically necessary" is not what you think

There will never be a time when insurance covers you because the term "medically necessary" means something that you need to survive, not just something that you want. Even cleft lip repair is something they have thought of not covering because you can live with a cleft...so save your money and pay for an augmentation when you can get one.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Insurance coverage for breast implants- good luck with that

The decision for insurance to pay for your breast implants will come down to a few important factors- 1. How 'good' your insurance coverage is 2. Can the augmentation on the smaller side be justified as 'reconstructive' rather than cosmetic 3. Will the insurance pay for augmentation of the 'normal breast' I think you're going to have a hard time getting this quasi-cosmetic procedure approved by any insurance company. The companies I... more

Scott Sattler, MD
Bellevue Plastic Surgeon

Insurance Will Cover Breast Implants Only for Breast Cancer Reconstruction

The only situation in which insurance companies will pay for breast implants is when breast cancer is involved. This is due to a national law which requires them to do so. There is coverage both for the breast which was partially or completely removed as well as the opposite breast for symmetry, but only when there is a diagnosis of breast cancer, not for fibroadenomas, etc.