Breast Reduction Went Wrong: Will Insurance Cover a Revision?

Thank you for the question.

Unfortunately, there is no way of knowing what a specific insurance company will deem “medically necessary” and covered by their plan. It will be in your best interest to visit with a well experienced board-certified plastic surgeon who can approach the insurance company on your behalf. The more support you have from your other treating physicians the better.

Best wishes.

There is no easy answer to your question.  Based on your story, you do seem to be a good candidate.  However, it really is dependent on your insurance company and your doctor.  So, I would suggest working closely with your doctor and your insurance company to make sure that every effort is made to help get your surgery covered by insurance.

 

Good Luck.

Usually, if a breast reduction was covered by insurance, additional surgery to deal with complications would also be covered. However, your revisional surgery involved implants, which are, in most instances, not covered except for in breast reconstruction after mastectomy. The rule of thumb is that if the insurer paid for those implants, they will probably also pay for correction---unless your policy provisions have changed or their clinical guidelines have been modified since the time of the last surgery. From your posting, I haven't quite figured out how you went from a reduction for back pain to implants but the full history is something you can definitely discuss with a board certified plastic surgeon in consultation. I would recommend that you obtain a complete copy of your medical records from the initial treating doctor or, if he is no longer available, from the hospital at which the procedures were performed so that any plastic surgeon you see now can get the full picture. Good luck!