Diagnosed Capsular Contractor with pain and in need of medical statement from surgeon that will file to insurance.

In March, my PS diagnosed me w/ CC and said it was so far gone that I would need surgery. I told that it was causing me pain and was told I had the wty coverage for replacement, but later told they were mistaken and I would have to pay out of pocket. I asked my medical ins whether it would be cover. I was told if given a medical review with a what and why for surgery it would be covered. My PS will not file ins. I am in need of a PS in ATL for capsulectomy that will give statement and file w/ins

Doctor Answers 4

CC and insurance

In my experience, I have not found insurance companies willing to pay for treatment of a capsular contracture. Check with your insurance company.


New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Capsular Contracture

In my experience most insurance companies do not pay for this surgery but each company and each plan is different.

I recommend looking on the website for your insurance company. There should be a list of plastic surgeons that take your insurance. Start with that list and call their offices and find out if the surgeon will be willing to write a letter for insurance preapproval.

Personally, I am always willing to write a letter but I never guarantee that the insurance will cover it. I've seen many instances that someone at the company tells a person that it is covered when in fact they reject it in the long run. This is incredibly frustrating for all involved.

Good luck!

Jennifer Boll, MD
Tempe Plastic Surgeon
5.0 out of 5 stars 7 reviews

Insurance

It is very uncommon for insurance to cover any complications of cosmetic surgery , including capsules. There is nothing wrong w sending a letter and trying. But don't get your hopes up.  Good luck, and I'm sorry you find yourself in this situation.  

Virgil Willard, MD
High Point Plastic Surgeon

Treating Capsular Contracture & Insurance

Capsular Contraction is the #scar tissue that forms around the #implant is a natural response to a foreign object implanted in the body. The capsule can tighten and squeeze the implant making it firm. This is referred to as capsular contracture. This firmness (breast capsule) can range from slight to very hard. The firmest ones can cause varying degrees of discomfort or pain. #CapsularContracture can occur in one breast or both.

Those experiencing this are candidates for Breast Revision Surgery. An implant revision or exchange intends to replace the damaged implants with new silicone or saline filled implants with newer technology. Secondary breast surgery can be complex and needs to be done by an experienced plastic surgeon. The specific procedure to be performed will depend on the complications experienced and the condition of the implants.

Each insurance policy has different guidelines and exclusions. Although, many practices do not accept insurance, their staff may be to assist patients by providing a pre-authorization form so you may attempt to be reimbursed for any out of pocket expenses.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 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.