How to get insurance to pay for breast implants that are leaking and possible has mold behind them? Blue Cross/Blue Shield.

Question

Having to go on disability and 2 doctors has diagnose possible leakage and mold. Insurance want pay for surgery because implants put in originally for cosmetic. Now sick, hard to take care of child and self because of symptoms. X-ray shows up white stuff on chest wall.

Larry S. Nichter, MD, MS, FACS · Answer

Many insurance policies may no longer cover problems related to cosmetic surgery. Mold though possible is unlikely (in my 30 yrs of practice I have never seen or heard of a colleague with a similar case). You can appeal to your insurance company but if you have another denial you might consider a university based plastic surgical program residency clinic for best price option.

Daniel Butz, MD · Answer

Unless the implants were placed for reconstructive reasons most insurance companies won't cover the cost of revisionary surgery. You need to look at your specific contract but they normally have small print related to complications related to cosmetic procedures. 
Some implant companies offer programs to help offset the cost but normally you need to pay for these before your surgery. 
Hope this helps.

David Liland, MD · Answer

Some Insurance companies have policies that state they will not cover cosmetic surgery and issues with them. Period. I have never seen a reversal of decision in that  situation. If you feel you are having health issues related and cannot afford to pay for the removal perhaps you can find a university program that has state and federal funding that will take care of you as required by law....if you can prove your situation. Fortunately I have never seen mold in any implant removal in 22 years of my private plastic surgery career and and I have performed MANY implant removals for many different reasons but never because I suspected mold.Best of luck for a speedy return to better health.

Gustavo E. Galante, MD · Answer

It is not likely that any insurance company will pay for complications as a result of implants placed for cosmetic purposes.

Jourdan Gottlieb, MD · Answer

It would be helpful to know the basis of the suspicion of leakage and mold. Nonetheless, many, probably most, policies exclude from coverage any complications of cosmetic surgery. And of course it is not clear that anything to do with the implants is the cause of your symptoms. Usually removing implants is comparatively inexpensive. All the best.

How to get insurance to pay for breast implants that are leaking and possible has mold behind them? Blue Cross/Blue Shield.

Answers (5)