Why Don't Insurance Companies Cover Breast Implants?

Doctor Answers (12)

Breast implants and insurance

+2

The basic philosophy of medical insurance is to cover treatments that are "medically necessary" for your health and survival. Premiums are collected from patients to cover these costs. So, if your insurance paid for your implants, technically it would be the other patients who were buying your implants and that would not be appropriate and would seriously raise everybody's premiums.


Seattle Plastic Surgeon
5.0 out of 5 stars 51 reviews

Coverage for Breast Implants and Insurance

+1

By law, insurance companies must pay for implants used in breast reconstruction associated with cancer.  In fact, before 1998 even breast cancer reconstruction was not universally covered because insurance executives did not think that having breasts were "medically necessary" . It took a law to make that happen.  Everything else will be considered cosmetic and not be covered. Every insurance is different with the exception that they profit by not paying for health care services. There is a perverse incentive to collect premiums from consumers and not pay for care. You have to be your strongest advocate for your health. As a consumer, call your insurance company and make your case. I bet you doctor will arm you with all the medical documentation.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.0 out of 5 stars 15 reviews

Insurance and breast implants

+1

Insurance will cover for breast implants if these are part of a reconstruction for breast cancer. Other than that you are on your own.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

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Insurance coverage for breast implants

+1

Hi,

Thank you for your question!

Insurance companies will cover breast implants if they are medically necessary. They are only medically necessary after a mastectomy/breast cancer in terms of breast reconstruction.

Insurance companies will not cover any procedures that are for cosmetic purposes and not necessary. This unfortunately includes breast implants.

Best regards,

Dr. Speron

Sam Speron, MD
Chicago Plastic Surgeon

Insurance coverage of breast implants

+1

Insurance will cover breast implants if they are being placed for reconstruction, as for example after mastectomy for breast cancer. They will not cover any cosmetic surgery, including breast augmentation, breast lift, tummy tuck, etc.

Nina S. Naidu, MD, FACS
New York Plastic Surgeon
4.0 out of 5 stars 5 reviews

No insurance coverage for elective cosmetic surgery

+1

I feel your question is why does insurance not cover cosmetic operations including breast implants. Simply there is no coverage or benefits for non necessary surgery. If you do not have a functional deformity than NO insurance company will cover COSMETIC SURGERY. Hope this answers your direct question. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 64 reviews

Insurance companies coverage of breast implants

+1

Hi Babydoll - Insurance companies only cover breast implants when they are used for breast reconstruction after trauma or after a mastectomy for breast cancer.  If the implants are to be placed for cosmetic reasons, then insurance companies won't cover the costs.

Jeffrey E. Schreiber, MD, FACS
Baltimore Plastic Surgeon
5.0 out of 5 stars 78 reviews

Cosmetic procedures not covered by insurance

+1

Insurance companies deem certain procedures as not being medically necessary. Breast implants, breast augmentation and breast lift are included in this category. Even physical conditions which can have tremendous psychological implications are excluded from insurance coverage such as breast augmentation for congenital abnormalities.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 10 reviews

Sometimes insurance companies DO cover breast implants: depends on the indication

+1

Generally speaking, insurance companies will pay for medically necessary or functional surgery but will deny coverage of cosmetic procedures. When breast implants are used for breast reconstruction, they will typically pay. When implants are used for cosmetic purposes, it will most commonly be denied. There is confusion about congenital breast deformities but as time passes, these companies seem to deny more and more procedures.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 48 reviews

Medical insurance companies are keeping costs down

+1

Hello,

Basic to medical insurance is the attempt to collect as much as they can and cover as little as they can. Long ago the concept of denying procedures as cosmetic became accepted. In plastic surgery, most things follow from there.

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 24 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.