How Much Would It Cost to Fix Symmetric Sagging Tuberous Breast Deformity with Insurance in the New York City/Long Island Area?

Doctor Answers 9

Correction of Tuberous Breast Deformities and Insurance

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Unfortunately, insurance companies generally do not cover this given there is no history of breast cancer.  Correction of tuberous breasts generally involve cosmetic self-pay procedures.  Please visit with a board certified plastic surgeon to learn more about your options.

Cingenital constricted (tuberous aka tubular) breast deformity

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It sounds as if Dr.s Naidu and Rosenblatt have the most personal experience with NY state carriers but in Illinois it is quite rare to get insurance coverage of congenital constricted breast deformities.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Costs of Breast Surgery

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Prices vary from city to city and state to state.  I agree that you should go to a few consultations and find a surgeon that you feel comfortable with.  Just keep in mind that all surgeons are not created equal and when you are talking about having surgery, your first priority should not be finding the best bargain.  Good luck.

Tuberous breasts in NYC

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Unfortunately, insurance will not cover treating sagging tuberous breasts. This is considered cosmetic and you would have to pay out of pocket.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Health insurance fee schedules

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I doubt your insurance would cover this surgery. Be sure to get a preauthorization from your insurance before you do the surgery or you might be surprised with a large bill.

Assuming it is covered by insurance there is a second part to your post that is important i.e. what do you have to pay out of pocket for a procedure covered by insurance. If it's covered they pay part of the bill but how big is that part.

Historically speaking, prior to the 1950s there was no such thing as health insurance. Patients simply paid their physicians. With increasing technology, liability & other costs the average individual could no longer afford health care & the health insurance industry arose to fulfill a need. There were separate policies for hospital care & others for health care professionals. However, patients paid their bills & were reimbursed by their insurance company. This arrangement changed in the 1950s through 1960s when insurance premiums rose & insurance companies paid the bills directly. Copays & deductibles were introduced to prevent overutilization of services by patients. Most policies were independently purchased by subscribers.

In the 1970s the introduction of better computers allowed the codification of services provided by doctors & hospitals & the diagnoses of patients. Then services supplied by different health care providers could be compared including their fees. Much of this was government initiated to control Medicare and Medicaid budgets. The government set out to assign work units to different codes & say how much it would pay for different codes. The private insurance companies in general were paying 2 to 3 times the amount of the government's corresponding fees. The amount paid per code was based on the usual, customary & reasonable amount in the area where services were delivered i.e. what the average doctor was charging. Simultaneously the government began forcing employers to buy health insurance for their employees & offer HMO plans to them. This has continued to the present so that currently an individual may find it impossible to purchase non-HMO health insurance on his/her own. The risk pool for individual plans has shrunk to the point where it is unprofitable for health insurance companies.

Since the insurance companies now had very large portions of the patient pool under their control they began to influence healthcare to maximize their profits by controlling the delivery & cost of care. While the government based its payments on having a fixed amount of money to spend on healthcare & controlling this as a percentage of inflation & GNP the insurance companies thought differently. Over the past 15 years the government decreased it's fee schedule for procedures dramatically. The insurance companies followed suit dropping from 2 to 3 times the government fee to 1.5 to 2 times. They have continued this to the level of 1.1 to 1.2 times the government fee. In some cases they are offering contracts of 0.6 to 0.7 times the government. Coupled with greater than 50% increases in premiums, corrected for inflation in the last 20 years they are making a bundle. They are picking fee schedules which they call allowed amounts that maximize their profits & pegging them to the government rate. This is particularly troublesome since the government rate relates to federal budgets & has nothing to do with how much it costs to deliver those services. Non-government insurance should not be pegged to government rates. In fact in New York the insurance companies were sued for gaming the system with respect to setting fee schedules for procedures in their favor. The result was a large class action lawsuit payout by those companies followed by business as usual.

Calling the amount they think my services are worth "allowed amount" on the explanation of benefits given to patient subscribers is misleading if not an outright lie. The column should be labeled what we will pay for these procedures in order to maximize our profits & damn the doctor because we don't care how much it costs him to maintain an office etc.. We also don't care if he/she makes a profit.

If I lowered my fees to whatever the insurance companies would like to pay me I would be out of business in a short time or just be working to be able to work & have a no account office. If you have a problem with this I suggest you call government legislators in your state & Washington to rectify the matter. I doubt they will do much as insurance companies are very big campaign contributors and judging from TARP, obamacare, wall street bailouts etc those entities matter more to politicians than the care and wellbeing of indiviual citizens.

If you try to compare insurance companies by asking how much they pay for specific procedures when shopping for a policy they will tell you it's proprietary information i.e. a trade secret. How can you be an educated consumer when you do not know the value of what you are buyin?. If you push them they will tell you to go elsewhere. It is no wonder that the majority of personal bankruptcies today are due to medical bills and the majority of those people did in fact have health insurance. The younger healthier people then see health insurance as a waste of money and do not want to pay for it. The government then turns around and passes a law forcing people to buy this garbage. This is not very different from the passage of EMTALA in 1999 to force doctors to see patients without pay in the emergency rooms. Doctors have been taking care of patients in this setting for decades the insurance companies then began to squeeze the payments for this care so the doctors refused to deliver that care. Instead of making the insurance companies pay those bills the brilliant thinkers in Washington passed laws forcing doctors to deliver uncompensated care. Now if the bone is not sticking out through the skin you have to go home and call around till you find a doctor who will care for you when in the past those matters were addressed within 48 hours.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Cost to Fix Symmetric Sagging Tuberous Breast Deformity with Insurance in the New York City/Long Island Area?

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Around $8,000 to $10,000 since no insurance will cover this type of cosmetic surgery in the USA. Best to see 3 boarded surgeons in your area. From MIAMI Dr. Darryl J. Blinski

Speak to a doctor

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Insurance does not cover this. Each doctor has their own fees - go get some consultations.. Then you can decide who to use.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Insurance for Tuberous Breast Repair?

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The easy answer to this is that insurance does not generally cover this repair.  Since there is no functional impairment, most insurance companies see this procedure as cosmetic and so they do no offer coverage.

Sorry about that...

Tuberous breast deformity and insurance

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This depends entirely on your insurance plan.  Many insurance plans will not cover correction of tuberous breast deformity.  Some do, and how much is covered depends upon your individual plan.  I suggest calling your insurance company to see if this is covered, and if it is, ask for a list of plastic surgeons who accept your plan.  Good luck, /nsn.

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.