Am I able to get reimbursed for breast implants that were leaking silicone?

In August 2015 my breast implants (after breast reconstruction) were replaced because both were leaking silicone, according to an ultrasound and by the surgeon who replaced them. The implants were guaranteed for 10 years, but only lasted 8 years. Now Allergan won’t reimburse me because my surgeon threw away the implants instead of sending them to Allergan. I informed him before surgery that they were under warrantee. What are my options?

Doctor Answers 5

Am I able to get reimbursed for breast implants that were leaking silicone?

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Hello!  Thank you for your question!  If your implants were placed for breast reconstruction, the implants along with the procedures themselves, should be covered benefits through your insurance. The warranty typically applies more for breast augmentation.  I would discuss any further concerns with your surgeon. Rupture of implants is a potential complication of any breast implant procedure. Best wishes!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Reconstruction Implant Issues

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It is unfortunate that you are having this issue.  However, the cost of the implants should not factor into this problem.  Reconstruction for patients after mastectomy is absolutely covered by insurance companies according to Federal law so there should not be any issue.  It is not necessary to keep the implants to get all the claims paid.

Reimbursement for silicone ruptures.

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Dear Barbara,
If your implants were placed for breast reconstruction your insurance company likely covered the cost of your implants, and I would guess that was why your surgeon did not return the implants to Allergan. If he had, the money should have gone to your insurance company and not you. Even if the total cost of your surgery was reduced by the cost of your implants your copay and deductible would likely be the same or very nearly so. 

Stacey Folk, MD
Denver Plastic Surgeon
4.8 out of 5 stars 25 reviews

Reimbursement for Leaking Implants

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Thank you for your question.   Implant companies require return of implants for reimbursement.  This would usually apply to cosmetic surgery cases where a patient has a significant out of pocket expense for revisional surgery.  If your surgery was reconstructive, less your copay and deductible, your insurance company should cover the cost of your surgery.    If you had an out-of-pocket expense for revision, solely due to a failed implant, your doctor could have had the implants returned to Allergan.    The implant company policy would have determined your level of reimbursement.     Hope this helps!

Stephen Bresnick, MD
Los Angeles Plastic Surgeon
4.8 out of 5 stars 34 reviews

Insurance coverage of breast implants

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Thank you for the question. I'm terribly sorry about your implants. 

Because these implants were used for breast reconstruction, your insurance should cover the expense of the implants and the surgery (minus deductible based on your individual health plan coverage). It is mandated by law that insurance companies cover breast reconstruction. If these implants were placed for cosmetic purposes, then you likely won't get them reimbursed. Hope this helps! Best of luck to you!

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