Will Insurance Cover Correction of Breast Asymmetry?

Question

I have breast asymmetry. My right one is a B cup and my left one, a D cup. Will my insurance cover this?

Brian K. Reedy, MD · Answer

Thanks for your question.
Reach out to your insurance company to see if this is a covered benefit. Schedule a consultation with a board certified plastic surgeon to diss your options. Best wishes.

Young R. Cho, MD, PhD · Answer

Thank you for your question.  You may need to attempt providing documentation to see if insurance would cover such a procedure.  There is a better chance if there are symptoms associated with the larger size.Breast asymmetry is very common, particularly size asymmetry.  If you are looking to decrease the asymmetry from one breast to another, then you have several options.
1)  You can reduce the larger breast with liposuction
2)  You can enlarge the smaller one with fat grafting or an implant
3)  You can enlarge both but use different size implants
4)  A lift procedure may also be needed to help address differences in shape and nipple position.I would visit with a board certified plastic surgeon to discuss your options in more detail and who can submit appropriate documentation to the insurance company.

Ben Lee, MD · Answer

The answer lies entirely with your insurance company. Even if it is a covered benefit, it will take some footwork on the part of you and your plastic surgeons office to get the paperwork together to get the procedure approved.  Also bear in mind that with high deductible insurance, you may not save that much if at all by going through your insurance carrier.

Otto Joseph Placik, MD · Answer

In the vast majority of instances in which I have submitted claims for congenital breast asymmetry, the benefits have been denied by the insurance company despite being supported by the patients internist, family practitioner, psychologist, and gynecologist.

Robert L. Kraft, MD, FACS · Answer

Thank you for your question.  If the larger breast is big enough to qualify for a breast reduction under your insurance criteria, then coverage may be available for a unilateral reduction.  However, insurance companies will not pay for augmentation of the smaller breast.  As you may know, they cover reconstruction after mastectomy, but only based on federal legislation mandating this and do not extend the same courtesy to patients with breast asymmetry.

Aaron Stone, MD · Answer

That depends on the wording of your insurance policy. You need to look at the policy to see what the coverage of developmental and congenital abnormalities is. Some have age limits or other criteria. Changing insurance may not be an option because of pre-existing condition clauses. If you have symptoms like back or neck pain because of the condition then you would have coverage provided you meet whatever the coverage criteria of the policy are -3 months of conservative treatment, symptoms of a 1 year duration or more etc.

Will Insurance Cover Correction of Breast Asymmetry?

Answers (6)

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