Breast implant revision covered by insurance?

Question

Hi all. Was curious as to if any drs would do a breast revision and it would be covered by insurance? I had capsular contracture in my left breast that was hard but has since gotten soft due to having kids but has pain that shots up around the side periodically. My right breast has a leak I’m sure as it’s smaller than the left and has continuous irritation while wearing a bra due to it rubbing from not being the same size. My insurance plan indicates it could be covered but be medically necessary. Do the above conditions deem anything as a medical necessary?

Mats Hagstrom, MD (license on probation) · Answer

Certain breast procedures are covered under medical insurance.
This generally includes treatment of symptomatic capsular contraction.
Some plastic surgeons will be happy to work with insurance compensation, and some will not.
Recognize that insurance compensation is usually quite small compared to customary fees for cosmetic surgery.
 Often, a combination of cash, cosmetic surgery and insurance based revision surgery can be done.
This can help the patient get the operating room and anesthesia fees, covered or partially covered while the surgeon still gets compensated fairly.
A surgeon cannot charge the patient for the same procedure. They build the insurance company for.
They can however, bill for other procedures that are cosmetic.
For example, if you have surgery for a capsule contraction that’s covered by insurance the surgeon can also charge you for re-augmentation.
To me, this is reasonable and appropriate for both sides.
It sounds like you’re going to need new implants and some capsular work that will most likely be covered by insurance.
An accurate assessment will require an in person consultation and at that time you can ask each provider if they work with insurance reimbursement or not.
Before scheduling consultations, you can also call plastic surgeons offices, and ask if they’re willing to work with medical insurance for your condition.
You may want to schedule a few consultations with different plastic surgeons in your community to see what they have to say.
Unless you go with your original provider, you should also bring copies of before and after pictures and idea a copy of your operative report.
These are part of your medical records that you should be able to request from your original provider unless it’s been long enough that they have disposed of your records. This varies from state to state but typically between six and 10 years.
If your original surgeon is still in practice, then it’s likely they have your medical records which you should request a copy of. At least a copy of the operative report and all pictures taken.
This will be very helpful to any surgeon doing a secondary procedure.
Best,
Mats Hagstrom MD

Breast implant revision covered by insurance?

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