Does Having Breast Implants Affect Health Coverage?

Question

Is it true that women with Breast implants may have a problem getting health coverage?

Steven Teitelbaum, MD · Answer

Most insurance policies do not cover any future surgeries related to breast augmentation if the implant was placed for cosmetic purposes.  Since there are no systemic health issues related to breast implants, why should this be an issue?
Once in a while, we hear of women denied health coverage because of their breast implants.  So far, we are only aware of such cases of women applying for "individual policies," not with "group policies."  In other words, if you are getting your insurance through work or your husband's work, I have not yet heard of their being a problem.
The cases in which there have been denials ahve been with so-called indivdual policies, which is people getting insurance totally on their own.  But these policies are insanely restrictive: they'll turn people down for taking one medicine or having had one minor surgery in the past.    One day such people are approved for indivudal policies, and the next day they are not.  The insurers are unreasonable, arbitrary, and capricious.
We have worked with insurance companies in the past explaining to them that women with breast implants are in fact very good people to insure and that the presence of an implant - whether saline or silicone - does not in one iota affect their insurability in any other way.
So the bottom line answer is that though it shouldn't, with some insurance companies, and some policy types, there have been denials.

Darrick E. Antell, MD, FACS · Answer

This is a question to be asked of your health insurance company. As physicians, we treat our patients to the best of our medical ability, but I have little knowledge about health insurance.

	Health insurance is a contract between you and your insurance company. The variety of plans available, can differ greatly in terms of coverage which is why premiums vary.

	Insurance companies are not your friend, despite their frequently warm fuzzy ads, they are a business out to maximize their profit, and any time they pay an insurance claim, it is viewed as a loss. So they have strong motivation to delay payment, burden you with paperwork, have confusing contracts which you need a law degree to interpret and part of their business plan is to make reimbursement so complicated and prolonged that they know a large percentage of people will just give up.

	Having stated the above, I have never heard of person with breast implants being denied health insurance.

Otto Joseph Placik, MD · Answer

Yes, this may affect you health coverage. It is not likely that you will be denied health coverage. However, it is possible that you will be issued a rider or an exclusion for coverage of breast issues or breast related conditions or problems.
For example if you sustain a complication of the implants that requires removal or biopsyt or if you need an MRI to evaluate implant integrity, these may not be covered by your insurance policy.
Each insurance company handles these claims differently and you may want to inquire as to their specific policies.

Farbod Esmailian, MD · Answer

This is the first time I have heard of this.  I dont believe it is an issue.  Also, health insurance companies ask about any medical problems you have had in the past and surgeries you have had, but I know of many who have changed insurance companies after their surgeries and have had no issues.

Shaun Parson, MD · Answer

Thank you for the question.  You should not have any issues obtaining health insurance after having breast augmentation.  I have never heard of any patient having this kind of problem and I'm not aware that it could ever be used as an exclusionary criteria for insurance.  Hope this helps.

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Answer: Breast Augmentation and Health Coverage

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