Is Hypoplastic Breast Reconstruction Covered Under Insurance?

Question

Lewis Albert Andres, MD · Answer

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!

Jerry Lugger, MD · Answer

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.

Kamran Khoobehi, MD · Answer

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.

Craig Harrison, MD · Answer

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

Tal T. Roudner, MD, FACS · Answer

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

Is Hypoplastic Breast Reconstruction Covered Under Insurance?

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Answer: Hypoplastic breast insurance coverage

Answer: Hypoplastic breast insurance coverage

Answer: Is Hypoplastic Breast Reconstruction covered by insurance?

Answer: Is Hypoplastic Breast Reconstruction covered by insurance?

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Is Hypoplastic Breast Reconstruction Covered Under Insurance?

Answers (7)

Answer: Hypoplastic breast insurance coverage

Answer: Hypoplastic breast insurance coverage

Answer: Is Hypoplastic Breast Reconstruction covered by insurance?

Answer: Is Hypoplastic Breast Reconstruction covered by insurance?

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Recommended reading

Everything you need to know about Breast Reconstruction

Our mission is to create a world where every investment in modern beauty is Worth It.