Is Hypoplastic Breast Reconstruction Covered Under Insurance?

Hello! Thank you for your question! Surgical procedures for aesthetic
purposes, to improve appearance, are not covered by insurance.
Typically, these as well as complications resulting from such procedures
are the responsibility of the patient. Procedures that are meant to
correct functional issues and those which cause health-related issues
should be covered by your insurance as a medical necessity, with proper
examination and documentation. Some insurance plans have exclusion
criteria for certain procedures. Also, it is an obligation of the
surgeon not to attempt to authorize purely cosmetic procedures through
insurance. Discuss your issues and
complaints with a board-certified plastic surgeon to discuss these as
well as to examine and assist you in deciding which procedure(s) will be
the best for you. A discussion of the advantages and disadvantages will
take place along with the risks and benefits. Insurance companies will
vary on coverage and is always reasonable to discuss your issues with
your surgeon and primary care. It would behoove you to get as much
information as possible and even call your insurance yourself.
Certainly, pay in advance prior to your surgical procedure and options
such as financing are available if you qualify. Hope that this helps!
Best wishes!

Unfortunately most insurance carriers consider this a cosmetic procedure now;  I occasionally got this covered a number of years ago, but it is routinely denied now.  If the correction involves a component of soft tissue reconstruction (e.g. a flap reconstruction) it might be that a pre-determination would be worthwhile, but certainly no guarantees could be made that this would afford insurance coverage.

If you have true breast deformity ,your insurance may cover it if requires reconstruction rather than augmentation .  Depending on your insurance company and their restrictions, reconstruction may be covered. The most common diagnosis that covered is Poland's syndrome which is complete absence of the breast tissue.

Occasionally a onesided hypoplastic breast may be covered by generous insurance carrier. Visit with a local plastic surgeon for an evaluation and if deemed appropriate a predetermination letter can assess the possibility of your carriers coverage. Good luck

Hypoplastic breast or more commonly know as small breasts are treated by breast augmentation and is a procedure not covered by health insurance!