Breast Augmentation: Q&A
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Does Insurance Cover Tubular Breasts Since It is Considered a 'Congenital Anomaly' ?
My insurance company is united healthcare. I live in NYC so if there are any doctors who are willing to work with me and my insurance company please email me at MyElectroFetish@aim.com
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13 Doctor Answers |
Asked by
Ally23
in New York
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Insurance coverage for plastic surgery procedures
Insurance policies, even with the same company, can vary widely. It is always advisable to get in writing from the insurance company a predetermination as to whether the specific procedure you are considering is covered under your insurance policy. If they deny it, you have several options. One is to appeal and they should tell you what the appeal procedure is. Another is to proceed with the surgery on a cosmetic, self-pay basis and there are financing options available is that is an issue...
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Insurance company and tubular breasts
I have had several patients with tubular breast deformities and several refusals by insurance companies. You have to look closely at your policy. They base their refusal to cover this congenital deformity by indicating that a physical DISABILITY must accompany the congenital deformity in order for coverage to be approved. Having said that I am sure your surgeon will gladly work with you and assist you to obtain approval from your insurance company.
West Palm Beach Plastic Surgeon
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Insurance coverage for tuberous breasts
Usually insurance will only cover breast surgery if there is associated breast cancer or hypermastia. I have never had a tuberous breast deformity covered. Donald R. Nunn MD Plastic Surgeon.
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Anomaly is not a deformity
Although there are different grades of tubular breast, the correction procedure is not covered by insurance companies. But, to satisfy your curiosity, try contacting your insurance company and see what they say. Personally, I have not seen a case of tubular breast covered by any insurance company. It is a cosmetic procedure and your local plastic surgeon will advise you on the type of surgery and cost. Good luck
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Insurance coverage for tubular breasts
In most cases, insurance companies consider tubular breast surgery a cosmetic procedure. However, it never hurts to contact your insurance company to check on your individual policy. As plastic surgeons, we have no control over what the insurance company will cover. After a consultation, we can write a letter and send photos and maybe a sympathetic insurance company would agree to cover it, but don't hold your breath - insurance companies generally try to find any...
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Surgery for tubular breasts is usually not considered reconstructive.
The same thing applies to protruding ears, large noses, and even large breasts, though insurance coverage is sometimes obtainable for breasts large enough to exceed certain height/weight guidelines.
But, tuberous breasts are generally considered "cosmetic" in nature by most insurance companies. You should see one or more ABPS-certified plastic surgeons in New York who can tell you honestly what your chances are of obtaining coverage. Truthfully, I would expect them to be low. I...
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Does Insurance Cover Tubular Breasts Since It is Considered a 'Congenital Anomaly' ?
I'm not sure if you are asking a "why" question or looking for boarded New York PS's to write a predetermination letter to UnitedHealth? If your deformity is severe tuberous and amastia/hypomastia with asymmetry than you may be approved. But in general tuberous symmetrical deformities are rarely approved, especially with UnitedHealth Care. If you had posted a photo we could be more specific upon your possible chances for approval.
In the predetermination...
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Insurance coverage for tubular breasts
Although tubular breasts may be considered a congenital anomaly, insurance companies generally tend to limit coverage to issues that create a functional problem (reconstructions after breast cancer are an exception, and coverage is required by federal law). You should be able to find a plastic surgeon on your insurance plan who is willing to see you and then submit a pre-determination letter to your insurance company. If you are denied, you can appeal the decision, and sometimes your...
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A matter of degree
Like any congenital deformity there are matters of degree. Many breasts are labeled tubular that are mild enough to constitute cosmetic problems. Most insurance companies have lower limits of tissue resection to consider a breast reduction "functional" and eligible for coverage. Tubular breasts in their more severe forms are truly a deformity, but there is no clear line (like a weight) that insurance companies can use to objectively determine the need for coverage...
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Insurance Coverage for Tubular Breast Surgery
I agree with the other surgeons- obtaining coverage can be difficult, but it is not necessarily impossible. Whether or not you are eligible to have insurance coverage for surgery will depend on how severely you are affected and on your insurance plan's "specific plan benefit". The specific plan benefit is essentially the contact you have with your insurer that specifies whether of not such surgery might be covered or is automatically excluded from coverage. If it might be...
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Tubular Breast Deformity Insurance Coverage
Tubular breasts are a congenital breast condition and in theory should be covered by insurance and considered a reconstructive procedure. Although I have been a strong patient advocate on this matter and have expressed the medical necessity and reconstructive nature of the problem citing many sources of literature, I have yet to see an insurance company approve this surgery, always considering it "cosmetic".
Your surgeon may have better luck, but I have found dealing with...
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Insurance and non cancerous breast deformities.
It is an uphill battle to get third party payor coverage of non tumor or most congenital breast conditions. Breast cancer and breast reduction cases have had the
best track record for success. Check with your insurance carrier for their position.
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It's your insurance
Toady's insurance wants to pay as little as it can for procedures that may be life saving. Thus. for mostly cosmetic procedures they rarely cover it. Most of us will work with you , we will write a letter, and enclose photos to try to help you obtain coverage, but in the end, it is your insurance company and if they decide not to cover it, it is your responsibility. Although tubular breasts are a congenital issue and we may consider the surgery reconstructive, the insurance company may...
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