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Possiblibity of Prior Auth for Implants for a 20yr.old Girl with Estrogen Deficit Anolomy

asked 11 months ago by reno911 in Oshkosh, WI
Latest answer by Barry L. Eppley, MD, DMD
Question viewed 132 times
Tags: age 18-24, estrogen, insurance

My niece has a documented estrogen deficit and is on estrogen therapy in order to menstruate since age 16. She has no breast development, and would like implants to have a normal body. Is there any chance a prior authorization could be done to have insurance coverage for the procedure? (she is mearly looking to have some normalcy--A cups would make her happy) Does insurance always consider this an cosmetic elective procedure?

3 answers to Possiblibity of Prior Auth for Implants for a 20yr.old Girl with Estrogen Deficit Anolomy

+1

Insurance Coverage For Implants For Congenital Breast Defects

The chances of insurance providing coverage for breast 'reconstruction' for this condition is about as close to zero as I can imagine. Even in cases of profound medical reasoning, many breast procedures are denied today due to lack of a functional benefit. However, the only way to know for sure is to consult with a plastic surgeon and have a predetermination letter submitted. This letter will outline the medical diagnosis, proposed treatment plan and will have photographs to... more
Barry L. Eppley, MD, DMD

Indianapolis Plastic Surgeon

www.eppleyplasticsurgery.com

+1

Insurance coverage for breast implants

Insurance coverage is quite variable for breast implants, even with a well documented medical condition. If your endocrinologist feels that with replacement therapy there will be no further breast development a letter of support and an appeal to your insurance provider in the form of a predetermination of benefits will sort things out. Best of luck, peterejohnsonmd
Peter E. Johnson, MD

Chicago Plastic Surgeon

www.peterejohnsonmd.com

+1

Insurance coverage for breast defects

Hi, unfortunately, insurance companies will almost always consider this a cosmetic case, even in the face of an obvious underlying medical cause. You can call your insurance company yourself and given them the code 19325 (breast augmentation) if they ask for it. Best wishes, /nsn.
Nina S. Naidu, MD

New York Plastic Surgeon

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