I have small breasts (barely A) and many fibroadenomas in one of them that are growing and I keep finding more. I will need to have them removed at some point and I'm wondering if, because it is a medical necessity, my health insurance will pay for me to get implants afterwards, as I will likely end up with almost no breast on one side.
Answer: Coverage By Insurance Is Rare Unfortunately, most insurance companies only cover the expense of treating breast asymmetry when it’s associated with breast cancer.They view this type of procedure as purely cosmetic.Rarely, insurance carriers will cover the expense of these procedures when they’re associated with functional impairment.This usually requires going through the prior authorization process to establish medical necessity.This is usually always unsuccessful.
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Answer: Coverage By Insurance Is Rare Unfortunately, most insurance companies only cover the expense of treating breast asymmetry when it’s associated with breast cancer.They view this type of procedure as purely cosmetic.Rarely, insurance carriers will cover the expense of these procedures when they’re associated with functional impairment.This usually requires going through the prior authorization process to establish medical necessity.This is usually always unsuccessful.
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January 21, 2011
Answer: Submit insurance letter with supporting photographs documenting deformity
It is most probable that implants will NOT be covered for benign disease. However, if you have a compelling story and dramatic differences, consider having your general surgeon compose a letter with supporting photographs requesting a predetermination of benefits. Perhaps the reviewer would be sympathetic to your cause (unlikely) but it may be worth a chance if the difference is as pronounced as you state.
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January 21, 2011
Answer: Submit insurance letter with supporting photographs documenting deformity
It is most probable that implants will NOT be covered for benign disease. However, if you have a compelling story and dramatic differences, consider having your general surgeon compose a letter with supporting photographs requesting a predetermination of benefits. Perhaps the reviewer would be sympathetic to your cause (unlikely) but it may be worth a chance if the difference is as pronounced as you state.
Helpful
January 21, 2011
Answer: Insurance coverage for breast implants- good luck with that
The decision for insurance to pay for your breast implants will come down to a few important factors-
1. How 'good' your insurance coverage is
2. Can the augmentation on the smaller side be justified as 'reconstructive' rather than cosmetic
3. Will the insurance pay for augmentation of the 'normal breast'
I think you're going to have a hard time getting this quasi-cosmetic procedure approved by any insurance company. The companies I work with (Premera, Regence and BC) would reject the claim.
Breast reconstruction for cancer, on the other hand, is a federally mandated covered benefit. Insurance companies deny breast reconstruction claims at their peril.
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January 21, 2011
Answer: Insurance coverage for breast implants- good luck with that
The decision for insurance to pay for your breast implants will come down to a few important factors-
1. How 'good' your insurance coverage is
2. Can the augmentation on the smaller side be justified as 'reconstructive' rather than cosmetic
3. Will the insurance pay for augmentation of the 'normal breast'
I think you're going to have a hard time getting this quasi-cosmetic procedure approved by any insurance company. The companies I work with (Premera, Regence and BC) would reject the claim.
Breast reconstruction for cancer, on the other hand, is a federally mandated covered benefit. Insurance companies deny breast reconstruction claims at their peril.
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July 17, 2013
Answer: Insurance companies and breast implant coverage
By law, insurance companies must pay for implants used in breast reconstruction associated with cancer. Everything else will be considered cosmetic 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.
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July 17, 2013
Answer: Insurance companies and breast implant coverage
By law, insurance companies must pay for implants used in breast reconstruction associated with cancer. Everything else will be considered cosmetic 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.
Helpful
February 6, 2011
Answer: Breast implant coverage
If you have mastectomies for prophylaxis you are a candidate for reconstruction and your insurance company should cover that.
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February 6, 2011
Answer: Breast implant coverage
If you have mastectomies for prophylaxis you are a candidate for reconstruction and your insurance company should cover that.
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