What insurance co. will cover explant capsulectomy along with medicare supplemental insurance during open enrollment time?

I have been extremely ILL which I know is from the PS who did a reconstructive surgery on me in 2005. He reused my implants which to my understanding Menor states they are a one time device only. Now I have 6 scar capsules with biofilm/surgical mesh inside my body. I have been unable to tolerate pain since that surgery. The implants he encountered weren't even the ones on my implant card. Beings the surgeon used the old implants isn't there some insurance company that could cover this?

Doctor Answers 3

Removal

If your surgery was reconstructive surgery after breast cancer, your insurance company should cover the removal. All other procedures are considered cosmetic and probably not covered. Medicare covers removal of ruptured old gel implants and sometimes capsular contracture and removal for infection.


San Antonio Plastic Surgeon
4.6 out of 5 stars 13 reviews

What insurance co. will cover explant capsulectomy along with medicare supplemental insurance during open enrollment time?

The insurance company works for you, not your surgeon.  Once your surgeon has made his recommendations, contact your insurance company regarding your benefits.  It is unlikely this will be a covered procedure.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 55 reviews

What insurance co. will cover explant capsulectomy along with medicare supplemental insurance during open enrollment time?

I'm sorry you are having so much difficulty. Insurance companies do sometimes cover that surgery when the implant is ruptured, and also sometimes for severe capsular contracture,  but it is my understanding that if you are under Medicare, every insurance company will only deal follow Medicare rules. By way of explanation regarding your implants, they are a ONE PERSON device (not a one time device) and commonly reused in the same patient during a revision if they are in good shape in order to save the patient a good deal of money. Capsular contracture and biofilm risks are known complications of these procedures and you personally accept that risk when you request a surgeon place implants in your breasts. Nevertheless we hate to see unhappy patients with unsatisfactory results and hope you do better with your next surgery. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 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.