Would Insurance Cover the Cost of Plastic Surgery for a Congenital Birth Defect?

I have turners syndrome. Do to the congenital defect I have almost no breast tissue and widely spaced nipples. Would insurance ever cover the cost of having this corrected?

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5 Doctor Answers | Asked by missally

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Sometimes insurance covers the cost of plastic surgery for congenital problems with breast development.

Thank you for your question. While no one can give you a specific answer in this venue, here is some general information that my help. Insurance companies typically cover conditions that cause a functional problem and are medically necessary. If a condition causes problems with self-confidence and self-esteem and the surgery is designed to improve appearance, then this is usually considered cosmetic in nature and not covered by insurance. Each insurance... more

Does insurance cover congenital problems with the breast?

Turners syndrome can lead to hypoplasia of breast tissue and a wide-spaced appearance to the breast. Although this is congenital, in my experience it is difficult to get insurance companies to pay for correction of these problems. These companies are rarely interested in how a patient "looks" or "feels". That being said, it could be of value to contact your insurance company, directly and ask them about their coverage for this problem. I wish you well. more

Probably not

Insurance companies are very strict about coverage for surgery to improve your breasts unless you have breast cancer. You should see a board certified plastic surgeon to be evaluated. He/she should apply for prior approval from your insurance company so you know where you stand. Turner's Syndrome has other findings than breasts. I recommend you see an endocrinologist before you do any kind of surgery.

Insurance coverage for Turner's syndrome

It has been one of my great frustrations that insurance companies in NY have done everything possible to avoid paying for congenital and developmental defects such as Turners and Pollan's syndromes. They pay for reconstruction after mastectomy only because federal law mandates that they do so. I am not optimistic that you will be able to have the procedure covered by insurance but would encourage you to review your plan specifications in detail. The insurers use the standard of... more

Insurance Coverage for Congenital Birth Defect Reconstruction?

Thank you for the question. Yes, it is possible that health insurance will cover breast reconstruction to repair congenital birth defects. The best way to know for sure is to contact your specific insurance company and ask about your policy and procedures that may be covered. I would also suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons... more