Follow-up: Does insurance cover tuberous breast since it is abnormal?

Question

I know there is no health concern with tuberous breast but is there anyway around it? Any recommendations?

Farah Naz Khan, MD · Answer

No, this is considered a cosmetic surgery. It's probably best to find a board certified plastic surgeon who takes the time to properly examine you and recommend the best procedure for you to improve your breast aesthetics. Good luck!

Leila Kasrai, MD, FRCSC · Answer

Unfortunately, insurance doesn’t usually cover tuberous breast correction since it is considered a cosmetic issue.

Gregory Baum, MD · Answer

Thanks for your question. I have had several tuberous breast deformity pts. have their surgery covered by insurance. It really depends on your insurance carrier and to some degree, who review your file that day. They have guidelines but they are just that....guidelines, not absolutes. I always prepare my pts. that the surgery may be deemed cosmetic and thus not covered by insurance. The insurance carriers say they cover congenital breast deformities so sometimes I will submit the info coverage although I'm realistic about the chances of being approved.  I hope this helps. Good luck.

Richard H. Tholen, MD, FACS · Answer

No.I also believe it is disingenuous to ask you to talk to various breast surgeons as if the "right" questions, letters to insurance, or the "right surgeon" might be able to achieve coverage for tuberous breasts. THIS WILL NOT HAPPEN!I have been a reviewer for Blue Cross/Blue Shield as well as for Medicare, and have never approved breast surgery for tuberous breasts. Somewhere, I suspect this might have occurred, but I suspect it would only be approved if there was incorrect information supplied or unethical practices carried out.Sorry, but this surgery is elective and self-pay, so you owe it to yourself to find the best surgeon, not one who implies that coverage might be possible (It won't.) Best wishes! Dr. Tholen

Donovan Rosas, MD · Answer

The only way to be sure about what will or will not be covered by insurance is to make a formal inquiry. Your board certified plastic surgeon should be able to guide you both in developing a treatment plan as well as discussing the financial options available to you.Anecdotally speaking, in my experience, I am not aware of correction of tuberous breast deformity for reasons of cosmesis being covered by insurance. Insurance typically covers reconstruction or procedures performed out of medical necessity.As always, discuss your concerns with your board certified plastic surgeon.

Aldo Guerra, MD · Answer

Hello Yaddie,I'm not sure medical insurance will cover tuberous breast surgery, but you really have to reach out to plastic surgeons in your area to find out. My guess would be not likely if there are no medical concerns and the surgery is done for cosmetic improvement.

Warmest regards,

Dr. ALDO

Warmest regards,

Dr. ALDO

John P. Stratis, MD · Answer

You would do well to check with your insurance company but I have never seen insurance cover tuberous breast correction. They do cover reconstruction for breast cancer in most cases and in some cases will cover congenital absence of one breast.

Steven Wallach, MD · Answer

No, insurance does not cover tuberous breasts.  Treatment of tuberous breasts is strictly considered cosmetic.

Tom J. Pousti, MD · Answer

I have not had any success obtaining health insurance coverage for patients undergoing corrective surgery for tuberous breasts.   Key to success will be careful selection of plastic surgeon; make sure that you work with a board-certified plastic surgeon who can demonstrate lots of experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully as well. You may find the attached link, dedicated to corrective surgery for patients with tuberous/constricted breasts helpful to you as you learn more. Best wishes.

Follow-up: Does insurance cover tuberous breast since it is abnormal?

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