I got implants in 2016. My doctor went too big against what I requested. I suffer from fungal rashes, pain. Discomfort neck pain. Back pains. Migraines and also have developed capsular contracture III & IV in both breasts. I would like to know if there's a possibility I can get a removal and lift covered by insurance. Does it still qualify as a reduction if I have implants? Wouldn't an explant be the reduction? Is it a separate procedure? Anything helps. ATL area.
Answer: Insurance Coverage Insurance companies see things through a very narrow lens. You did not have implants placed in 2016 to correct for mastectomy or congenital deformity, and so they consider it cosmetic. The only sequela from breast augmentation they are willing to pay for is capsular contracture, and the surgery would be explantation. A surgeon can bill for that and still perform re-augmentation and breast lift, but that you would pay for. To complicate matters worse, your insurance plan has potential rules and regulations regarding how much or even if they will reimburse your surgeon for explantation and capsulectomy. Start this process by calling your insurance company and finding out about explantation for capsular contracture after cosmetic breast augmentation.
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Answer: Insurance Coverage Insurance companies see things through a very narrow lens. You did not have implants placed in 2016 to correct for mastectomy or congenital deformity, and so they consider it cosmetic. The only sequela from breast augmentation they are willing to pay for is capsular contracture, and the surgery would be explantation. A surgeon can bill for that and still perform re-augmentation and breast lift, but that you would pay for. To complicate matters worse, your insurance plan has potential rules and regulations regarding how much or even if they will reimburse your surgeon for explantation and capsulectomy. Start this process by calling your insurance company and finding out about explantation for capsular contracture after cosmetic breast augmentation.
Helpful 1 person found this helpful
Answer: Possible but Unlikely You have multiple options that may work for you. Some companies will pay for implant removal only if there are issues with the implants. If your natural breast tissue needs a formal reduction, typically defined as about 500g or more of tissue (about 1lb) per breast, insurance will cover a formal breast reduction (and lift) at the time of explant. However, if your implants are otherwise intact and your breast tissue is relatively minimal, it is likely that you will need to pay for the procedure out of pocket.
Helpful
Answer: Possible but Unlikely You have multiple options that may work for you. Some companies will pay for implant removal only if there are issues with the implants. If your natural breast tissue needs a formal reduction, typically defined as about 500g or more of tissue (about 1lb) per breast, insurance will cover a formal breast reduction (and lift) at the time of explant. However, if your implants are otherwise intact and your breast tissue is relatively minimal, it is likely that you will need to pay for the procedure out of pocket.
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June 14, 2024
Answer: Implants No, insurance does not cover anything with implants unless it is for reconstruction after a mastectomy. Exchanging implants for ones smaller is not considered a reduction. A reduction is a partial mastectomy that removes excess breast tissue and skin.
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June 14, 2024
Answer: Implants No, insurance does not cover anything with implants unless it is for reconstruction after a mastectomy. Exchanging implants for ones smaller is not considered a reduction. A reduction is a partial mastectomy that removes excess breast tissue and skin.
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June 7, 2024
Answer: Explant and lift Thanks for your question! It is pretty unlikely that your insurance would come into play here. Most insurance companies would consider this cosmetic in nature. I would suggest calling your insurance company and seeing what they say. Good luck!
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June 7, 2024
Answer: Explant and lift Thanks for your question! It is pretty unlikely that your insurance would come into play here. Most insurance companies would consider this cosmetic in nature. I would suggest calling your insurance company and seeing what they say. Good luck!
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June 4, 2024
Answer: Will insurance cover breast reduction w/lift if I have implants? Hi,
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June 4, 2024
Answer: Will insurance cover breast reduction w/lift if I have implants? Hi,
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May 28, 2024
Answer: Insurance coverage In most cases insurance companies do not deem implant removal as medically necessary and therefore do not provide coverage. You can call your insurance company for clarification, but this is typically considered cosmetic.
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May 28, 2024
Answer: Insurance coverage In most cases insurance companies do not deem implant removal as medically necessary and therefore do not provide coverage. You can call your insurance company for clarification, but this is typically considered cosmetic.
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