Breast implants can be an expensive procedure, so it is important to understand your insurance coverage and options. Medical insurance companies generally do not cover the cost of breast augmentation or other plastic surgery procedures that are considered cosmetic. However, if you are having a reconstructive procedure due to illness, injury, congenital defect, or deformity, it may be covered by your health insurance provider. Other exceptions may include post-mastectomy breast reconstruction and revision surgeries following an initial breast augmentation.
Does Insurance Cover Breast Implants?
In most cases, the answer is no; insurance does not cover breast implants. Insurance companies do not provide coverage for breast augmentation and other plastic surgery procedures that are generally considered elective cosmetic surgeries because they are non-essential treatments. While this is applicable to many health insurance plans, exceptions do exist depending on the specifics of the situation.
In these instances, coverage may be provided if a doctor has prescribed or recommended the procedure due to medical necessity. This could include post-injury reconstruction or mastectomy in certain cases. Additionally, some policies may also offer partial or full coverage for revisions or enhancements of an existing breast augmentation that have been medically recommended or necessary.
Does Insurance Cover Breast Implant Removal?
When considering whether or not health insurance may cover the cost of breast implant removal, factors such as medical necessity, recalls on the devices used for the surgery, infection or other side effects resulting from the procedure must be taken into account. If any of these apply to you, it is worth applying for coverage. In some cases, medical necessity could include situations in which pain and other medical issues arise due to complications associated with the implants.
Additionally, some policies may cover implant removal due to a recall on the devices used for your surgery or, if you experience infection or other side effects related to the surgery, your insurance provider may cover the cost of a revision procedure or removing the implants entirely.
Does Insurance Cover Capsular Contracture?
Capsular contracture is an unfortunate complication that can occur after a breast augmentation procedure. It is caused by the capsule surrounding the implant tightening, hardening the tissue and changing the shape of the implant. While not all insurers cover capsular contracture, thankfully, in some instances, insurance may provide recourse by covering capsular contracture if it is deemed to be medically necessary and, as such, require payment.
Treatment options can range from replacing or removing the affected implants to undergoing revision surgery if recurrent capsular contracture occurs. Additionally, your insurance provider may also cover revision surgery if you experience recurrent capsular contracture that requires further surgical intervention.
Will Insurance Cover Breast Augmentation for Asymmetry?
In some cases, insurance may cover a breast augmentation procedure if it is determined to be medically necessary for the correction of a congenital abnormality or deformity such as congenital asymmetry. This could include reconstructive surgery due to injury or deformity, or a procedure recommended by your doctor to improve health-related concerns.
In these instances, coverage for the surgery can vary depending on the policy and provider. Therefore, in order for the procedure to be covered, your doctor will need to document that the condition causes significant emotional distress and that other treatments have been attempted without success.
Does Insurance Cover Breast Implants After Mastectomy?
Yes, in some cases insurance may cover breast implant after a mastectomy. This is commonly referred to as post-mastectomy reconstruction and is usually covered under most medical insurance policies, although there may be other exceptions depending on your policy and provider.
It can include the cost of the implant itself, as well as any other necessary treatments or procedures associated with the surgery. For example, some policies may also cover revision surgeries following an initial breast augmentation. However, some policies may have stipulations regarding coverage for post-mastectomy reconstruction that should be discussed with your provider prior to obtaining treatment.
How to Get Breast Implants Covered by Insurance?
In order to get breast implants covered by insurance, you will need to meet certain criteria that are outlined in your health insurance policy. Generally speaking, the procedure must be deemed medically necessary and treatment should usually be recommended by a doctor specializing in plastic surgery. In addition to this, your policy may also require pre-authorization or prior approval from your provider.
Furthermore, if the procedure is related to a reconstructive surgery following mastectomy or injury, there may be additional requirements for coverage specified in the policy. It is important to speak with your provider and review your policy thoroughly so that you understand all of the requirements for coverage before proceeding with any medical procedures.
Conclusion
When considering breast augmentation, it is important to understand the financial implications and any potential coverage provided by your health insurance policy. In general, breast implants are not covered by health insurance.
However, if you are undergoing a reconstructive procedure for medical reasons or to improve the function of the breasts, such as after a mastectomy, there is a chance that your insurance company will cover some of the costs. Additionally, if you experience complications following a procedure such as infection or capsular contracture, your provider may also offer coverage for revision surgeries or implant removal.
