How can I get insurance to cover for my breast implants removal?

Question

I've had my implants for 11 years now, and I am 51 years old. I've been having a bothersome consistent pain on my left implant. Also all of sudden I've been having sciatica pain and two really bad vertigo episodes on my left ear. So all of the bad things are happening on the left side of my body which indicates this is related to my left breast implant. How can I or what are the steps to follow to get my insurance to cover this procedure? I have anthem BC/BS.

Kenneth Hughes, MD · Answer

Sometimes saline implants can be removed under local anesthesia without performing any capsule removal or lift. Schedule a consultation with a board certified plastic surgeon who performs hundreds of breast surgeries annually for the best advice. 
Because breast implant surgery is elective, your insurance company may respond that it is not obligated to pay for special breast screenings, MRIs or implant removal.  Call your medical insurance provider to determine if they will defray some or all of the cost. 
Kenneth Hughes, MD, Board Certified Plastic Surgeon

Urmen Desai, MD, MPH, FACS · Answer

I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Frank Agullo, MD · Answer

This will by highly dependent on your insurance company and your surgeon’s willingness to help you with the approval process. Look for a plastic surgeon that accepts insurance not have an evaluation.

Himansu Shah, MD · Answer

Thank you for the question. It is difficult for insurance to cover removal of implants especially when implants were placed for breast augmentation. It is best to consult a board certified plastic surgeon. Good luck.

Daniel Barrett, MD · Answer

Dear Slimslip,it is unlikely that your insurance company will cover the cost of surgery. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thomas J. Lee, MD · Answer

Thank you for your question.  Every insurance company has different policies, so it is worth asking your current provider what coverage they can offer.  Pain near the implant is often associated with capsular contracture, which can also cause severe deformity of the breast.  Sciatica and vertigo are not commonly associated with breast implants.  If all you want is to have them removed, that can be safely done as an office procedure under local anesthesia at a lower cost than going to the operating room.

Jeanette Padgett, MD, FACS · Answer

Thank you for posting your question.  Most insurance companies will not cover removal of implants if they were placed for cosmetic reasons.  To be sure, contact your insurance company to see if your insurance plan will pay for removal.  Best wishes.

Diane I. Duncan, MD, FACS · Answer

Thanks for your question! Insurance usually only covers breast reconstruction with breast cancer, and breast reductions that qualify. Even if you were able to prove beyond the shadow of a doubt* (which will be difficult) that the implant is causing your symptoms, insurance is not obligated to cover. When it comes to cosmetic breast implants (not for the purpose of reconstruction), many will say that complications arising from the choice to have a cosmetic procedure is a self-selected pre-existing condition. Best of luck! *Even when it comes to reductions, the qualifiers for a reduction can include 3 months of physical therapy for skeletal pain, dermatologist visits for skin infections, and a certain amount of tissue must be removed in surgery for it to even be considered. Your symptom proof would need to be ironclad!

Stephen M. Davis, MD, FACS · Answer

Thanks for writing,Unfortunately insurance companies in our area will not cover the removal of implants. This can be done under local anesthesia and people can do well. Good LuckStephen M. Davis, MD, FACSCertified: American Board of Plastic SurgeryMember: American Society for Aesthetics Plastic SurgeryMember: American Society of Plastic Surgeons

Camille Cash, MD · Answer

I'm sorry you are having so many issues.  You need to call your insurance carrier to see if there is coverage for removal under your policy.  Typically breast implant removal is not covered unless the implants were placed for medical reasons (ie reconstruction after breast cancer).  If there is coverage your insurance carrier may require you to visit certain surgeons to have the procedure.

How can I get insurance to cover for my breast implants removal?

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