My lower back is killing me! Does insurance cover buttock reduction?

Question

About 2 years ago I got a Brazilian butt lift. Although I know it's the dream of every woman to have a big butt, I want it gone. I am 20 years old, 5'4 and the doctor injected about 1200cc in each side. I CAN'T stand my lower back, the pain was so intense a couple months ago I had to go to the hospital because I thought there was something serious going on. I am not as active anymore because too much movement hurts. Is there any way my insurance would cover a buttock reduction? HELP!

Dallas Buchanan, MD · Answer

Thank you for your question. Sorry to hear that you are not happy with the results. Perhaps some patients who are thinking about a BBL should talk to you to hear your story before they have the procedure. Although cosmetic surgery is not covered by insurance, sometimes procedures to undo cosmetic complications can be covered if it provides a risk to your health and wellness. For example, if someone has implant that rupture, sometimes the insurance will pay to have them removed but not replaced. Or if someone wants them out due to pain or discomfort, the insurance will pay for the removal but not a lift or other cosmetic concern. The problem in your case would be how to prove that the pain is caused by the BBL and that removing the injected tissue will resolve the pain, and that is going to be hard to prove. In addition, when submitting to the insurance for approval, each procedure has to have an associated CPT code and to remove your injected fat, the code needed would be a liposuction code likely and submitting this code to insurance for approval is usually a red flag that screams "cosmetic surgery" and is likely to earn a denial. Long story short, if you find a surgeon out there willing to jump through the hoops to try to get it approved, consider yourself lucky. But do not be surprised if despite his or her best efforts, you are unable to get this approved by insurance.Best of luck!

Arian Mowlavi, MD, FACS (license on probation) · Answer

There is not much precedence in this field since it is so new for all of us. I would see a surgeon in your field to see if it is covered. It is worth a chance but I would not get you hopes too high.

Mats Hagstrom, MD (license on probation) · Answer

It's possible that this procedure and could be covered by insurance.
While cosmetic surgery is generally never covered by medical insurance complications of cosmetic procedures often are covered.
In order for a surgical procedure to be covered it has to match at diagnosis which the treatment of as a covered medical benefit.
For example how do you developed an infection from your procedure the diagnosis to the insurance company would've been infection and not fat grafting or Brazilian butt lift.
Since the treatment of infections are always covered by medical insurance the complication would be covered.
This whole system is based on two sets of medical codes.
The codes for the diagnosis comes from a big catalog call the ICD 10
The code for all the various surgical procedures comes from the big catalog called the CPT catalog.
Each surgical procedure has an individual CPT code.
The key is to find an accurate and honest ICD 10 code or diagnosis code that leads to a covered procedure.
Sometimes doctors have to be creative because there could be several diagnoses that could.
For example the pain may be due to pressure on nerves.
A diagnosis for that could be neurapraxia.
If the treatment for neurapraxia is to surgically remove tissue that's pressing on your nerves then you could potential he get the procedure covered.
Front usual situations like this doctors have to be patient advocates, you some creativity but still follow the rules and be honest with the insurance company.
In your case it's also not certain that reducing your butt exercise would alleviate your pain.
Many plastic surgeons who focus to practices exclusively and cosmetic surgery or not interested in dealing with insurance companies.
For something like this at doctors office would spend a significant amount of time trying to get authorization and in the end of the reimbursement would be a tiny fraction of what the plastic surgeon would earn if the procedure was a cosmetic one paid for by the patient.
I suggest starting off by going to the surgeon who did your procedure and asking for his assistance.
He is the first and foremost person responsible for your well-being.
If he's not willing to work with you then your next option is to have multiple consultations until you find a plastic surgeon willing to work with you.
There is no yes or no answer to your question.
The best answer anyone can give you is maybe.
Best,
Mats Hagstrom M.D.

My lower back is killing me! Does insurance cover buttock reduction?

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My lower back is killing me! Does insurance cover buttock reduction?

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Our mission is to create a world where every investment in modern beauty is Worth It.