Insurance Coverage for Tuberous Breast Reconstruction?

I have had numerous cases of severe tuberous breast deformity aka constricted breasts denied by third party payors despite strong documentation and supporting letters from counselors, pediatricians, physical therapists, etc.
 

Generally, insurance companies do not cover the cost of tuberous breast correction surgery. This is because tuberous breasts are more of an aesthetic concern rather than health risk. However, you should ask your insurance provider if they do. 

At this time, most insurance companies will deem a tuberous breast deformity a cosmetic concern and will not deny coverage.  Although it is possible for you to appeal their decision.

I would not submit a tuberous breast procedure to an insurance company- its a cosmetic procedure with no functional benefit for the patient. Insurance companies are restrictive enough with breast operations that offer real benefit to patients (bilateral breast reduction, BRAVO study etc...) - they are going to deny any tuberous breast claim that is submitted.

Your best option is to find a surgeon that is experiences with this difficult operation and obtain a price quote for the procedures.

I do not know of an insurance company that will cover tuberous breast deformities.  It is usually deemed cosmetic.

In New York, insurance companies will not cover tuberous breast. I have tried many times to get it covered as it is a congenital anomaly, with no success. Every state is different but the likelihood it is covered in Colorado is probably low. The best way to find a plastic surgeon with expertise in this area is to get recommendations from other doctors such as ob/gyn, check with the American Board of Plastic Surgery to find board certified plastic surgeon, check with American Society of Plastic Surgeons (www.plasticsurgery.org)-all members are board certified and look for someone who does a lot of breast reconstruction or specializes in breast surgery. These surgeons will typically have the most experience with tuberous breast.
Also, the Allergan 410 implant, which is available through an FDA study is a good implant choice for tuberous breast. You can call Allergan and find out what plastic surgeon(s) in Colorado are on the study. These people probably also do a lot of breast surgery in general. Hope this helps.

In Pennsylvania the experience has been that less and less insurance companies have been covering the correction of these deformities. There is a better chance for coverage when you are younger rather than waiting until later in life. In addition severe, deformity that is unilateral will be more likely to be covered.
It is always worth a try but ...