Does Insurance Cover Fat Grafting to Improve Implants Post-breast Cancer?
Doctor Answers 5
Breast Reconstruction Fat Grafting Insurance Coverage issues
Theoretically your insurance is required to cover all breast reconstruction required following breast cancer surgery. The problem is that fat grafting is a new technique and may be considered "experimental" by your insurance company. A strong letter of necessity with pre-authorization from the company is suggested.
Here are the facts of the current federal law:
Women's Rights for Breast Reconstruction Following Mastectomy
The Federal Women's Health and Cancer Rights Act of 1998 is still the law today
Under the federal Women's Health and Cancer Rights Act of 1998, a yearly notification
of your benefits pertaining to breast reconstruction must be sent to you by your insurance company.
The Women's Health Care Act states that benefits must be provided for:
Reconstruction of a surgically removed breast
Surgery and reconstrcution of the other breast to produce a symmetrical appearance
Prostheses and treatment for physical complications from all stages of a mastectomy, including lymphedema
These benefits are subject to the conditions and terms of your plan, including maximum benefit amounts, deductibles,
copayments, and coinsurance provisions. The benefits are subject to your plan's exclusions and limitations.
Fat grafting to reconstructed breasts is covered by insurance
Indeed fat grafting is covered by insurance for breast reconstruction. It is a standard part of my practice and the majority of my patients who undergo breast reconstruction receive fat grafting. It is an ideal technique to improve contour and create a natural looking breast.
Insurance coverage for fat injections
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Insurance Coverage for Fat Grafintg to Breasts post-cancer
"Coverage" is a difficult word to define. Of course, post-mastectomy reconstruction is and should be a "covered" procedure but that doesn't mean that you can (necessarily) go to any surgeon you want and have the surgery paid-for. You have to work with your insurance company to find such a surgeon.
Fat grafting is a relatively new procedure and, as such, there may be some resistance to having the procedure "covered." Your best bet is to work with your plastic surgeon to have him or her contact your insurance company on your behalf (you can do it, too, but you may then have to convince a surgeon to do the procedure which will require him or her to get consent on their own) and find out exactly which procedure(s) are covered, and what the payments would be for that.
I hope that this helps and good luck,
Insurance Coverage of Fat Grafting to the breasts
Breast Reconstruction has changed significantly in the past 10 years but insurance company reimbursement has not.
Let's leave aside the potential merits of fat grafting in a reconstructed breasts and potential trade offs. Assuming your contract with your insurance company does have coverage for Breast Reconstruction (after all they did pay for breast reconstruction and ?expander/?implant exchange), this does not mean that they will pay for every procedure on the market. If the procedure does not have a CPT code that they accept, it will not be covered as they will call it "experimental".
Every insurance company is different and issues different policies. The fact that your Plastic surgeon did NOT suggest to you that your insurance will pay for it suggests to me that they do not pay for it. You may want to call them yourself and see.