Will Health Insurance Pay for My Breast Revision Surgery? (Part 1)

Will Health Insurance Pay for My Breast Revision Surgery? (Part 1)

Whether a health insurance company will cover the cost of breast revision surgery is a complicated question. Every person’s insurance is different. And each patient’s reason for a breast revision can be different as well – and the original reason for getting breast implants matters to the health insurance companies.

In this article we’ll explain how insurance companies frequently look at breast revision surgery. However, if you are considering breast revision surgery you should contact your insurance company. Our caring staff will be happy to help you do this.

Breast Revision Surgery for Implants after Cancer

The Women’s Health and Cancer Rights Act of 1998, protects woman who have undergone mastectomies. If a woman’s implants were put in after a mastectomy, and the doctor shows that removing the implants is now “medically necessary,” then the health insurance company must cover your breast implant revision surgery.

Breast Revision Surgery for Cosmetic Only Implants

If the original reason that a patient obtained breast augmentation of healthy breasts was purely cosmetic, then some health insurance companies will and some will not cover breast revision surgery.

Many insurance companies will cover breast implant removal or revision surgery if they consider the surgery to be “medically necessary,” but others will not.

Some insurance companies even expressly state in their policy that “complications from cosmetic surgery” are not included. Others may state this exclusion, but with some exceptions. For example if the breast implants under certain circumstances were consider “medically necessary” or “reconstructive” surgery.

What is “Medically Necessary” Breast Revision Surgery?

Different health insurance companies “define medically necessary” differently. The definition may also vary from state to state, as well.

It is important to recognize that just because your doctor thinks removing and/or replacing your breast implants is medically necessary, the health insurance policy may think otherwise. In some cases they may refuse to pay for breast revision if their policy’s definition of “medically necessary” differs from your doctor’s opinion.

Breast Revision Surgery Insurance Coverage

In some cases, more “generous” health insurance policies may consider the breast implant removal to be “medically necessary” if at least one of the following conditions is met:

  • Silicone gel implants that have ruptured
  • Baker III or Baker IV capsular contracture caused by saline or silicone implants
  • Necrosis (death of skin or tissue) due to the implant
  • Infection around the breast implant
  • A rare cancer called ALCL that can develop around breast implants

Click Here to Read Part 2: Proving Breast Revision Surgery is Medically Necessary

Troy, MI Area’s Top Breast Revision Surgeon

Top plastic surgeon Dr. Ali has provided breast revision surgery for thousands of patients across Oakland County and the greater Detroit area, including: Birmingham, Bloomfield Hills, West Bloomfield, Troy, Southfield, and more.

Because of his expertise, high standard of care, and exceptional results in even the most difficult cases, he is the surgeon that other physicians refer their patients to for breast revision surgery. With his years of expertise, caring demeanor and modern techniques, Dr. Ali can fix almost any breast implant problem, including: implant rupture, asymmetry, capsular contracture, implant size change, and more.

No matter what problems or issues you are having with your breast implants, board certified breast revision surgeon Dr. Ali will listen to your concerns and help you find the solution.

Consultation with Top Troy, MI Area Breast Revision Surgeon: 248-335-7200