Is Encapsulation Surgery Covered by Insurance?

Doctor Answers 5

Capsular contracture

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I do not believe that insurance companies will cover the payment for services realted to complications of cosmetice surgery.

Removing Scar tissue around breast implants is NOT paid by Insurance companies

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Medical insurance companies do NOT pay for Cosmetic Surgery nor for the complications of Cosmetic Surgery.  The situation may be different for Reconstructive Breast Surgery and depends on the insurance company.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Capsular Contracture and Insurance

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By law, insurance companies must pay for implants used in breast reconstruction associated with cancer.  In fact, before 1998 even breast cancer reconstruction was not universally covered because insurance executives did not think that having breasts were "medically necessary" . It took a law to make that happen.  Everything else will be considered cosmetic including capsular contracture and not be covered. Every insurance is different with the exception that they profit by not paying for health care services. There is a perverse incentive to collect premiums from consumers and not pay for care. You have to be your strongest advocate for your health. As a consumer, call your insurance company and make your case. I bet you doctor will arm you with all the medical documentation.

Is Encapsulation Surgery Covered by Insurance? Not typically

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Treatment of a capsular contracture tends to be covered only in instances of reconstructive surgery.  

Cosmetic implant encapsulation is not covered by insurance

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If you had breast implants placed for cosmetic reasons and then had some encapsulation the correctional surgery will always be considered cosmetic.  Insurance companies will not cover any form of cosmetic surgery.

Best Wishes.

Marcus L. Peterson, MD
Saint George Plastic Surgeon

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.