When Alloderm is used in a reconstruction or breast augmentation procedure, is the cost passed on to the patient? How much additional cost can be expected?
Is the Cost of Alloderm Passed on to the Patient?
Doctor Answers 10
Alloderm cost passed onto patient
For reconstructive cases, insurance will take care of fees of supplies associated with surgery (there is normally a "patients responsibility' portion - differs with each insurance). For cosmetic procedures that are not covered by insurance, the cost of using allograft is passed onto the patient.
Alloderm for breast reconstruction covered by insurance
The use of alloderm acellular matrix has in my opinion revolutionized breast reconstruction after mastectomy, by providing better support and coverage of the implant with less invasive surgery and more control over the shape of the breast. Breast reconstruction is a federally mandated insurance benefit and this would cover the implants and materials used.
It is a different story with revisions of breast augmentation. The material most often used here is Strattice, but insurance normally doesn't cover issues related to cosmetic surgery. However, for certain problems the use of a graft such as Strattice can prevent a lot of more expensive problems and additional surgery down the road.
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When Alloderm is used for breast reconstruction, it is often covered by the insurance companies. Most of the larger insurance companies include Alloderm in their coverage policies. Depending on your insurance company, they may cover any "dermal matrix" or only cover specific named products (such as Alloderm). This is important to discuss with your surgeon and to review with your insurance policy.
For cosmetic procedures, Alloderm (or the equivalent Strattice) is paid for by the patient just as the cost of the implants is passed on. Some surgeons may include these costs in their surgical fee. It is important to have this discussion prior to undergoing surgery and should be on the quote you are given from your surgeon.
Alloderm cost usually covered by insurance
Although in today's healthcare environment it is impossible to know for certain whether or not insurance will cover procedures, breast reconstruction after mastectomy is usually covered. Alloderm is usually covered as well when used for this purpose.
Alloderm covered by insurance
In breast reconstruction, Alloderm may be part of the reconstructive procedure and should be covered by your insurance. The costs of the Alloderm should not be passed to the patient.
Breast Reconstruction supplies not purchased by patients
In breast reconstruction, the implants and other supplies are NOT purchased by the patient. When Alloderm or Strattice are used in Reconstructive breast surgery the cost will NOT be passed to you individually (BUT - all higher expenses will result in higher premiums in the future to everybody).
The situation is different in Cosmetic breast surgery (Breast Augmentation, Lift, implant exchange etc). Here, insurance is out of this picture. YOU will decide which implants to pay for and if you choose to use Alloderm or Strattice, you will be paying for them.
Who pays for Alloderm?
The cost of Alloderm is absorbed by the insurance company, if the case is reconstructive in nature. There are established codes for breast reconstruction and hernia repair, which include the cost of Alloderm. It is an expensive product and its cost depends on both the size (cm) as well as thickness. LifeCell the company which makes Alloderm also makes Strattice (porcine "pig" acellular cadaveric dermal graft), which is slightly less expensive. In revisional cosmetic procedures, many surgeons favor Strattice both because of its price but also because of its greater rigidity, which can be used to improve "bottoming out", symmastia ("uniboob") or lateralization. The price is generally included in the surgeon's estimate. Good luck.
Reconstructive surgery is typically covered by insurance. Therefore, you should only be responsible for your copay, and deductiblle. In the event that it is not covered, someone has to pay for it, and my guess is that your plastic surgeon will include it in the cost estimate.