Can Insurance Pay for Breast Implants if It's Causing Very Serious Emotional and Self Esteem Issues?

Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses

It is unlikely insurance would pay for a breast augmentation.  Insurance usually covers medically necessary treatments, which in this case they would say is seeing a psychiatrist or psychologist to deal with the underlying emotional issues.  Surgery helps to improve one's body image in emotionally stable individuals.  If you have emotional issue that interfere with your daily functioning, surgery is unlikely to help.

In the US, all cosmetic procedures and related complications are not generally covered by insurance, although this may differ according to your insurance provider. It's best to ask them if they do.

        Insurance companies reimburse for less and less at the present time, and they were not reimbursing for breast augmentation in the past.  

 

 

Kenneth Hughes, MD Los Angeles, CA

Health insurance should be for unanticipated medical problems. Soliciting insurance company to pay for breast augmentation is absurd to me.

Thanks for your question.  In the state of Massachusetts, I am unaware of any insurance company that will pay for breast augmentation surgery to alleviate psychological duress.  Best to check your insurance company's specific policy and to read the exact policy language.  Best of luck.

Hi Kimberly.  Your question I not necessarily straightforward. First, every insurance policy is different. It constitutes a contract, stipulating allowable treatments. You need to check your specific policy to see what is and is not covered. Second, what's the problem? if it's just small breasts and you want big ones, I wouldn't be optimistic.  If however, there is a big difference between the breasts, an injury, or a congenital deformity, there's a decent chance that insurance will pay. The source of your emotional issues may be a valid problem for your insurance carrier, though the emotions might not be. Third, if you're out of luck with insurance and money is an issue, you might want to contact a local university plastic surgery program. They often have resident clinics where soon to be superstars can do your work at a steep discount. Best of luck!

Thanks very much for your question. Unfortunately I'm not aware of any insurance companies paying for breast augmentation for non-reconstructive reasons. It's even difficult at times to get them to pay for breast augmentation when it involves reconstruction in noncancer patients. I think you may find it difficult to have insurance cover this as a benefit.

I wish you luck pursuing this, but without a medical reason, it is highly unlikely that insurance will pay for this surgery.  

Most insurance companies deem breast augmentation procedures as not medically necessary.   Sorry, insurance will not cover your breast implants.