Will Medicaid cover a deformity? (Photo)

Question

clearly I have the Poland disease which is considered a birth defect. my left breast is way larger than my right OBVIOUSLY. I'm not understanding why this isn't considered an emergency because it's hard to find clothes and I'm tired of stuffing my bra with tissue and not feeling comfortable. can't we label this as something else because I definitely don't have the money to get it fixed

Sheila S. Nazarian, MD · Answer

You will need to call your insurance company and see what, exactly, they do and don't cover. Hope this helps and good luck -- Dr. Nazarian

Michael S. Beckenstein, MD · Answer

You definitely have an asymmetry that can benefit from surgery. Without an axamination, it may not be Poland's. Either way a combination of left reduction, right augmentation, should improve your appearance. Whether Medicaid will cover this is always a guess. The best way to proceed is to find a board certified plastic surgeon experienced with this, who takes Medicaid patients. A good bet would be a university setting.

Troy A. Pittman, MD, FACS · Answer

Thank you for your question.  Have you been diagnosed with Poland Syndrome?  There is another condition called Anterior Thoracic Hypoplasia that looks like Poland Syndrome however patients still have a pectoralis muscle.  I've had success with getting this condition covered by insurance but it really depends on your insurance carrier.

John J. Obi, MD · Answer

Thank you for your inquiry and the photo.  It is not possible to answer whether Medicaid would cover your procedure as they do not offer the prior approval process so you would know in advance.  Also, because the reimbursement from medicaid, should it be covered, is so minimal -usually less than the cost for the physician to perform the procedure- it may be difficult to find a Plastic Surgeon who is willing to assume the risks of this challenging procedure.You may benefit from visiting a Teaching institution where there is a Plastic Surgery Residency program as they maybe able to help you.Good Luck,JOhn J Obi, MD

Tom J. Pousti, MD · Answer

Your concerns are certainly understandable. Although you do not have a surgical "emergency", the very significant breast asymmetry can understandably caused both physical and psychosocial "distress". You will likely benefit from a breast lift/reduction of your left breast;  whether or not you will be able to have Medicaid cover the procedure is hard to know. It may also be challenging to find a well experienced board-certified plastic surgeons who still work with this "insurance entity".  Ultimately, it may be in your best interests to gradually save up and have the procedure done by  in or certified plastic surgeon in your area who can demonstrate significant experience achieving the types of outcomes you will be pleased with.  You may find the attached link, dedicated to breast asymmetry concerns, helpful to as you learn more. Best wishes.

Will Medicaid cover a deformity? (Photo)

Answers (5)