My left breast is a size A and my right is a size C almost D. If I were to get an asymmetric breast augmentation, would my insurance cover it?
Asymmetric Breast Augmentation?
Doctor Answers 15
No, it is extremely unlikely that your insurance company would pay correction of breast assymetry
No, it is extremely unlikely that your insurance company would pay for this because the procedure if for appearance and to improve self-esteem. Insurance companies pay for functional problems.
It is unlikely that your insurance will cover this. I have had 20 years of practice and insurance has never covered this procedure.
Health insurance and cosmetic surgery
That depends on your insurance company and the state you live in. The American Society of Plastic Surgeons coverage policy recommendations are that it should be covered. In reality most insurance companies will say that because their is no functional deficit they will not cover it. In California the state has an expanded definition of reconstructive surgery mandating coverage. That is basically if the appearance looks abnormal to the average person the corrective procedure is reconstructive and has to be covered by health insurance. If the difference between the 2 breasts is very large like an A vs. a DD then it would be covered here in California.
I have reviewed cases from New York state that were not covered but if the patient lived in California would have been covered by state law.
If the nipple areola complex and/or chest muscle is deficient or abnormal as well it is more likely that the insurance will cover corrective surgery no matter what state you live in.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
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Insurance coverage for asymmetry
Generally speaking, this is considered a cosmetic problem by insurance companies, and therefore is not covered by insurance. It never hurts though to check your coverage with your provider.
Breast asymmetry insurance coverage
Insurance companies require proof of medical necessity for any procedure that they will reimburse money. The problem that you describe is probably likely to be viewed by your insurance company as a cosmetic problem, and therefore will not pay for it. In certain cases where breast asymmetry is caused by a congenital deformity, then they might consider it, but even then they are difficult. Talk to a Board-certified plastic surgeon and find out for sure. Good luck.
Insurance coverage for breast asymmetry surgery
It depends to a large extent on insurance criteria. The insurance company will look for medical necessity. If you your PCP can prove that the procedure is medically necessary and correcting it would improve you medical condition, then you stand a better chance of getting approved. If it was determined by your insurance company that the procedure is cosmetic; they will deny coverage. I hope that is helpful.
Breast asymmetry if quite common but usually not to the extent that you describe. Nonetheless, correction of the problem is usually considered cosmetic by insurance companies. If you have the asymmetry as a result of a congenital problem, such as Poland's syndrome, however, they would be more likely to pay for it. You should consult with a plastic surgeon and get their opinion.
Breast asymmetry and insurance coverage
Unfortunately, in my experience in New York State, most insurance companies consider asymmetry a cosmetic condition and, therefore, do not cover procedures to correct it. The exception is if the patient is having a reduction on the larger side. As stated by others, what insurance companies will cover varies from state to state and by policy. The office of your board certified plastic surgeon should be able to help you sort this out. Often, the patient is given the "codes" and you can call your insurance carrier to find out if these codes are covered by your policy. In my office we have an insurance specialist who assists the patients with these types of issues. Good luck.
Tracy M. Pfeifer, MD
Breast Asymmetry and Health Insurance Coverage?
Thank you for the question.
Exactly what procedures a specific health insurance company will consider medically necessary will vary from one company and/or policy to another. For example, significant congenital breast asymmetry may be considered a covered benefit by some health insurance companies. It will be best for you to meet with well experienced board-certified plastic surgeons for advice and/or help interacting with the insurance company.
Asymmetric Breasts are cosmetic problem and insurance will not pay for repair
Unfortunately, asymmetric breasts - even severely asymmetric like in your case - is a cosmetic problem and insurance companies will never find a medical reason to pay for augmentation surgery. I agree that your best possibility of insurance coverage is to reduce the larger size...but this will leave you will two A cup breasts and is probably not what you want. If you want to have this repaired, you will need to pay for it yourself. Sorry.
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.