Will Insurance Cover Revision for Uneven Breast Reduction Results?

I had a Breast reduction done many years ago and have very painful scar tissue as a result of it. My breasts are also 2 VERY different sizes where do you find a bra with a B cup and a C cup : (

Will my insurance pay for this disaster to be corrected?

Doctor Answers 15

Breast Reduction Revision

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It really depends on your insurance, some will and some wont.  It just depends on who reviews the preauthorization paper work. 

You plastic surgeon will have to take pictures and submit it to the insurance company to see if they approve the surgery.  I would likley say they will not. 

Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

It depends on your insurance

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Coverage of breast reduction revison depends on your insurance.  You will most likely have to have your plastic surgeon submit pictures along with a letter of medical necessity to obtain preapproval.

Good luck.

David A. Robinson, MD
Munster Plastic Surgeon
4.7 out of 5 stars 46 reviews

Check with your insurance plan first

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It is important to check with your plan first if this type of revisional surgery is coverd. Next would be to find a plastic surgeon who participates in your plan. The other option is to have the surgery done by an experienced plastic surgeon, even though he/she might not be on your plan. He/she can still submit the claim, but your insurance might cover only part of the surgical cost. Some plans require preauthorization first and would not cover medical expenses retrograde. Good luck.

Find a plastic surgeon who works with insurance

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After being seen by a plastic surgeon who accepts your health care plan, they would make a decision as to whether this could be submitted to the carrier for coverage. You may also need to be referred to your plastic surgeon by your primary care manager if you have an HMO type plan. There truly is no way to know if your insurance will help you. I wish you well.

Dr Edwards

Your insurer will decide what is a covered procedure

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Once you have determined whether any surgical procedure is indicated, your plastic surgeon can provide you and your insurer with the appropriate codes. At that point you'll find out whether they cover the work or not.

There's just too much variation in the coverage for all the available plans out there for anyone to tell you 'yes or no'. That answer will need to come from your insurance company.

Best of luck.

Health insurance and cosmetic surgery

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Everyone's health insurance policy is different, however, in general, most health insurance plans do not cover any complications resulting from a cosmetic procedure. You have to read the fine print of your individual plan. It doesn't hurt to try and bill health insurance since they do cover these issues sometimes. However, there are very reasonable priced cosmetic insurance plans that can be purchased prior to your cosmetic procedure that cover complications resulting from the cosmetic procedure. Your plastic surgeon can give you information on these plans that are sold by a separate company. You can also ask your plastic surgeon if you are at increased risk of having a complication and thus worth the extra expense of obtaining the policy.
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
4.9 out of 5 stars 42 reviews

Insurance Rarely Covers Breast Reduction Revision

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Insurance companies in general are only concerned about solving functional problems (e.g back or breast pain, inability to wear clothes or exercise, etc). They are not concerned about cosmetic appearance and it his highly unlikely that they will cover any revisions for this purpose. I would return to your original surgeon who will likely discount his services if this was related to his surgery. There is a chance that they will cover because of your complaints of pain but unlikely.

Insurance coverage?

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Thank you for the question.

Every insurance company has different policy  as far as what are considered medically necessary and covered   benefits. Generally,  the more supporting documentation ( of medical necessity)  you have from your primary care physician and/or plastic surgeon the better your chances for obtaining coverage.

Best wishes.

Insurance coverage for a revision of a breast reduction

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Patients today have many great options in breast reduction surgery. Like all surgery, there are always the risks of certain complications such as an uneven scar. If this scar is causing significant discomfort, it may be possible to have the revision surgery covered by your insurance company. However keep in mind that every insurance plan is different than your best bet is to work with a board-certified plastic surgeon who has great deal of experience in breast contouring as well as scar revision. They will be able to assess your tissue, determine if you need a revision, and try to obtain preauthorization for this procedure for you

Unbalanced Breast Size

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Please check the eligibility requirements of your insurance plan first. These are usually posted on their website and include the Company's rules on how many grams (weight) per side should be resected, as well as their recommendations on whether you have "failed" conservative therapy (such as physical therapy, weight reduction, utilization of support bras, etc.). The Company's may also have a position on your BMI (Body Mass Index, weight in kg/ heigh in cm), which must conform to their position. These are the usual parameters required for patients with heavy breasts who wish to have reduction surgery to address their musculoskeletal symptoms.

In your case, you mentioned that your discomfort had been somewhat alleviated by the original procedure. Try to enlist your primary care physician to intercede on your behalf by writing a letter in support of the discomfort you have in the scar line. Also ask him/her if they know a Board Certified Plastic Surgeon, who has an active practice which includes breast reduction, who is also on your plan. By building a case and using "preferred providers" you may get some financial assistance. You may have to attach photographs to support your petition. Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.