Insurance Coverage For Breast Surgery?

Breast surgery candidates have two types of insurance that may be available for their breast surgery procedure today. Standard health insurance may cover all or a portion of the costs for breast augmentation, breast reduction, breast lift, and breast reconstruction surgery in select cases. There are also insurance plans that some plastic surgeons provide which cover expenses associated with possible complications that may occur after breast surgery.

Protecting Your Breast Surgery Investment
Women interested in breast augmentation, breast reduction, breast lift or breast reconstruction may receive pre-approval from their insurance company for the costs associated with their procedure. Yet, every insurance carrier has a different policy and each policy offers distinctive benefits for the different types of breast surgery. In fact, a woman interested in breast surgery compensation will have their case evaluated for medical necessity before approval of the expenses associated with the surgery. By the same token, there are some safeguards in place to protect women with a true need for breast surgery. The following offers a recap.

Breast Augmentation: The breast implants manufacturers often offer breast implant warranty programs that cover a breast augmentation patient’s need for reoperation should a breast implant leak or rupture ten years after the initial procedure. Some warranties provide insurance coverage for plastic surgeon, anesthesia, and facility fees.

Breast Reconstruction: Insurance coverage for breast reconstruction is governed in most states by local law. The Women’s Health and Cancer Rights Act of 1998 requires that post breast cancer victims be permitted authorization for insurance coverage that includes medical and surgical expenses to cover breast reconstruction. Most of the states follow this Act and insurance companies support the Act. Lumpectomy and radiation results of abnormalty are often covered by insurance as well. Post breast cancer patients may be covered for breast augmentation, breast lift, or breast reduction surgery.

Revision Breast Surgery: Breast revision surgery may be covered by insurance depending upon the reason for the procedure. For example, leaking or ruptured breast implants may be covered by insurance. Revision breast augmentation surgery due to capsular contracture may be covered by insurance companies. Though, some insurance companies do not provide coverage for breast revision surgery. Finally, revision breast surgery due to the mal-position of breast implants, the altered appearance of breast implants because of weight loss or gain, or concerns about systematic disease are not usually reasons for insurance companies to absorb the costs of revision breast surgery.

Breast Lift: The breast lift procedure may or may not be covered by insurance. Breast Lift cases involving congenital deformity or related to disease are usually seriously considered by insurance companies.

Breast Reduction Surgery: Breast reduction surgery is considered by insurance companies should the breast reduction surgery be required due to back, shoulder, or arm pain as well as skin conditions. Breast reduction insurance approval may not occur until after the procedure. Yet, breast reduction patients can commence the pre-approval process prior to breast reduction surgery.

Breast Surgery Complications: There is third party independent insurance coverage available through a number of plastic surgeons’ offices that applies to breast surgery complications. This type of insurance covers costs associated with the diagnosis, treatment and management of complications that occur within 30 days of breast surgery. The complications covered under this type of insurance may include complications such as infection, bleeding, DVT, and pulmonary embolism. Plastic surgeons may absorb the costs for this type of insurance policy.

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