I have Poland Syndrome - Will my insurance cover that?

Question

I want to get this operation done but i dont just have 7 thousands dollars - I have medical will they help with that due to it being a birth defect

James E. Murphy, MD, FACS · Answer

I have had patients with Poland Syndrome.  Unfortunately I have never had insurance cover the procedure. Without a cancer diagnosis the insurance companies don't consider reconstruction medically necessary.  I know it seems unnecessary to us but the insurance companies are pretty sticky when it comes to these sort of things.

Jon M. Grazer, MD, MPH, FACS · Answer

I have treated patients with  Poland syndrome, that have  had their insurance cover the surgery. However, each plan is indivuidualistic, and your physician  will need to precertify you to see  if the plan covers it.Yours,Jon M. Grazer, MD, MPH, FACS

Stephen M. Davis, MD, FACS · Answer

Unfortunately you insurance company is the answer. I have had both, covered and non-covered experience. You will have to contact them and see if it is a cover expense.Good LuckStephen M. Davis, MD, FACSGreen Hills Plastic Surgery

Joseph B. Eby, MD, FACS · Answer

Hello Riichgetrich, Thanks for your question I was able to treat several patient's with Polands syndrome when I worked at a major HMO plan. It really depends on your plan, the degree of asymmetry and your Plastic Surgeon and Primary Physician's consultation and evaluation as to whether your plan may cover surgery to help correct the asymmetry. Some plans have specific criteria for treating congenital breast deformities i.e. must be 1 or 2 cup size difference.  Polands syndrome has a wide variety of presentations/severity and asymmetry including possible absence of the Pectoralis muscle. I would seek out a Board Certified Plastic Surgeon who has performed many of these operations and can discuss the options and is willing to submit for pre-autherization through your insurance to see if it can be covered. Best of luck, Regards. Dr. Joseph Eby

Michael Carlisle, MD - Account Suspended · Answer

I have seen Poland's covered. Has to be submitted as a prior authorization to the insurance company. Sometimes they just say no and then you would have to pay cosmetic fee.

I have Poland Syndrome - Will my insurance cover that?

Answers (5)

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