Does Having Breast Implants Affect Health Coverage?

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

Doctor Answers 7

This is an issue at times

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Dr Teitelbaum explains it best. I have spoken with women who were applying for individual policies who have been markedly "uprated" as a result of having saline or silicone implants. I have discussed this with the medical director of a local managed care plan whose take was it was their perogative to do this. By virtue of the fact they won't cover a beneficiary for implant-related issues yet charge them more should be challenged. The bottom line is to check with your individual plan.

Dr Edwards

It is possible...

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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.

Steven Teitelbaum, MD
Los Angeles Plastic Surgeon
4.6 out of 5 stars 49 reviews

Insurance coverage may be affected by breast implants

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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.

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

Check with your provider prior to choosing one

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It is a good idea to check with your insurance provider regarding this specific issue. Some insurance policies might not cover any squelae of breast implants e.g rupture, capsule formation, etc.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Implants and health insurance

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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.

Shaun Parson, MD
Phoenix Plastic Surgeon
4.8 out of 5 stars 47 reviews

This is a question to be asked of your health insurance company

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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.

Darrick E. Antell, MD
Manhattan Plastic Surgeon
4.7 out of 5 stars 37 reviews

Breast Augmentation and Health Coverage

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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.


Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 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.