Will Insurance Pay for Complications Resulting from Breast Implants?

If something like a infection develops after getting breast implants, will the treatment of the infection be covered by insurance?

Doctor Answers 11

Insurance Coverage of Complications

Most, but not all, insurance cos. have an exclusion for complications resulting from cosmetic surgery.  You can check your policy to see if this exclusion is in your policy.  If so, then CosmetAssure is an option that you can consider.

Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Will insurance pay for complications resulting from breast implants?

Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient.  It is considered that the patient is knowingly accepting the risks of the aesthetic procedure as well as the potential complications that can arise from such. It should not be expected that these complications be covered by the health care premium of you and the other members for cosmetic surgery. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation.  Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Insurance coverage for complications from breast implants

The VAST majority of medical insurance companies do not cover / pay for ANY complications resulting from any cosmetic surgical procedure.

Their philosophy is that since they did not pay for the original procedure - why should they be financially responsible for any complications arising from it?

That is why any reader of these pages hears the SAME comment again and again - go to a real Plastic surgeon, one who is a member of The American Society of Plastic Surgeons (www.PlasticSurgery.org).

When you get the cheapest guy in town, your surgery will be done most likely by someone who is NOT board certified by The American Board of Plastic Surgery and as such the likelihood of complications (resulting in much greater expenses to you) will be high.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Not usually

In the US, all cosmetic procedures and related complications are not generally covered by insurance, although this may differ according to your insurance provider. It's best to ask them if they do.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Health Insurance and Cosmetic Complication?

Everyone's health insurance policy is different, however, in general, most health insurance plans do not cover any complications resulting from a cosmetic procedure.  You have to read the fine print of your individual plan.  However, there are very reasonable priced cosmetic insurance plans that can be purchased prior to your cosmetic procedure that cover complications resulting from the cosmetic procedure.  Your plastic surgeon can give you information on these plans that are sold by a separate company.  You can also ask your plastic surgeon if you are at increased risk of having a complication and thus worth the extra expense of obtaining the policy. 
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 47 reviews

Insurance Coverage and Breast implant complications

By law, insurance companies must pay for implants used in breast reconstruction associated with cancer.  Everything else will be considered cosmetic and not be covered including complication.. 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 your doctor will assist you with all the medical documentation.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.3 out of 5 stars 34 reviews

Insurance and breast augmentation

In general, most insurance companies will not cover complications related to cosmetic surgery, but they may. you should contact your insurance company.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Complications from implants and insurance

Insurance will generally not cover complications arising from cosmetic surgery, but you should check with your individual plan. There is a form of cosmetic surgery insurance called CosmetAssure, which is available in some states. This is usually very affordable and very worth it for peace of mind prior to elective surgery. Good luck, /nsn.

Nina S. Naidu, MD, FACS
New York Plastic Surgeon
4.7 out of 5 stars 13 reviews

Insurance Coverage for Breast Implant Complication

Unfortunately, insurance companies will usually not cover complications from cosmetic surgery. The only time insurance companies will cover implants and implant related complication is if you have undergone implant reconstruction for breast cancer. CosmetAssure is a qualified insurance program that helps cover some complications after cosmetic surgery.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 209 reviews

Insurance coverage for complications of breast implants

Unfortunately, insurance companies are increasingly denying coverage of medical conditions if they attribute them to the breast implants. Interestingly they will pay for complications of alcohol and tobacco abuse but not  always for breast implants.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 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.