Will Insurance Cover Breast Asymmetry Correction?

asked 11 months ago by andi4724 in Rochester, NY
Latest answer by Tom J. Pousti, MD
Question viewed 312 times
Tags: insurance

I was diagnosed with congenital breast asymmetry at age 16 (I am now 27) in which I had to have one implant placed in my left breast and a reduction on the right breast to correct this (insurance DID cover this). Now that it has been over 10 years, the implant needs to be replaced and has been causing me discomfort. Will my insurance company cover this?

8 answers to Will Insurance Cover Breast Asymmetry Correction?

Breast asymmetry insurance coverage

It is becoming more and more difficult in my experience to get these procedures covered. I would certainly try and send a predetermination letter via your plastic surgeon with as much documentation as possible including your previous procedure. If your carrier covers this, it may only be partial. Also if approved pay attention to the time limit they may put on this to be accomplished; some of my patients have had procedures approved for 3-6 mos. and not scheduled, then have... more

Jerry Lugger, MD
Dallas Plastic Surgeon

Breast Implant Revisionary Surgery?

Thank you for the question. Since your initial breast surgery was done to correct congenital breast asymmetry, there is a chance that revisionary surgery may be deemed “medically necessary” by health insurance companies. The only way to find out would be to seek authorization with the help of your plastic surgeon. Prepare to be persistent.

Tom J. Pousti, MD
San Diego Plastic Surgeon

www.poustiplasticsurgery.com

Breast asymmetry correction and insurance

Most often insurance will not cover these procedures, but sometimes they will, and it may come down to who is reviewing your case on that particular day. What is working in your favor is that the insurance company approved coverage for your initial surgery. If you are covered by the same company, then there may be a decent chance that they will cover a revision that needs to be performed, particularly if you are having symptoms from your implant. A letter from your plastic... more

Robert M. Grenley, MD
Seattle Plastic Surgeon

www.seattleplasticsurgery.com

Breast Revisional Surgery and Insurace Coverage.

There are many variables when dealing with an insurance company. If it is truly for a congenital deformity they might pay, (as they did in your case). They may pay for the revisional surgery, (that they paid once for), or they may not.. Important to document as much as you can. Old records may help. Other things that might help is the plastic surgeon being on your plan and experience of that plastic surgeon with that particular insurance company. Now... more

Jeffrey Roth, MD
Las Vegas Plastic Surgeon

Insurance coverage for breast revision

Insurance companies do not cover cosmetic procedures. However, if you have adequate documentation that your breast surgery is reconstructive in nature due to congenital defect then insurance may cover the revision surgery including implant replacement. Having had a prior procedure covered helps your case, however, the final decision is up to your specific insurance company to determine.

Adam Hamawy, MD
Westchester Plastic Surgeon

Insurance for breast implant replacement

Insurance often covers implant removal for rupture as a 'medical necessity' though implant replacement may not be unless the implant was reconstructive in nature. We feel that you have adequate documentation for a predetermination letter to your insurance company to sort out coverage. You may have to find a plastic surgeon in your insurance network though this should not be difficult in the NY area. Best of luck, peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon

Breast Augmentation and Insurance

You will have to check your insurance policy in regards to breast surgery coverage (or with the HR dept where you work) to see if your policy may cover your surgery. It can be quite challenging to get insurance to cover breast revision surgeries that aren't cancer related. Definitely consult with a PS in your area who takes your insurance, and they can guide you through the process. Generally, if you do get insurance coverage for your procedure, be prepared to still pay some out of... more