Whether you’re thinking about getting a breast augmentation or breast reduction, Will Insurance Cover Breast Augmentation For Asymmetry is an important question to ask yourself. There are so many things to consider before and after plastic surgery, and in this guide, we provide an overview of what it takes to get insurance coverage for breast implants.
If you have asymmetry then insurance should cover the cost. However, you need to understand why you have asymmetry and make sure it is a congenital breast deformity rather than an acquired deformity. If it’s congenital then insurance should cover the cost. In this guide, we find out Will Insurance Cover Breast Augmentation For Asymmetry, how to get insurance to pay for breast reduction, how to get insurance to pay for plastic surgery, and congenital breast deformity.
“Does insurance cover my breast procedure” Every plastic surgeon is asked this question.
Patients want to know if their abdominoplasty, breast reconstruction, or breast augmentation is covered by their insurance policy.
It can be a difficult question to answer, as there is so much variability in insurance coverage from company to company and even among individual policies.
Each case has to be considered individually, and the patient should not be given a specific answer until the insurance company has provided a written response.
Insurance coverage is unpredictable when it comes to women seeking breast implants, whether for breast reconstruction or aesthetic surgery.
However, breast reconstruction—post-breast cancer—is clearly the most straightforward when it comes to insurance coverage.
State laws govern provisions the insurers must follow in the area of medical and surgical benefits for mastectomies, as well as reconstructive surgeries following mastectomies.
In 1998, the Women’s Health and Cancer Rights Act (WHRCA) was added as an amendment to the Employee Retirement Income Security Act (ERISA) laws. It required insurance companies to cover breast reconstruction for women after mastectomy as a treatment of breast cancer. Eighty-three percent of states have legislation further supporting this Act.
Alabama, Georgia, Ohio, Colorado, and Hawaii do not have state legislation supporting the Act. In Massachusetts and Puerto Rico, legislation is pending.
If a patient has a mastectomy, the laws require coverage for reconstruction and balancing procedures on the opposite breast, as well as a prosthesis for patients who elect not to have reconstruction.
Some insurance companies cover deformity after lumpectomy and radiation, including balancing procedures on the opposite breast, but this varies among plans.
If FDA-approved, medical devices, such as tissue expanders and breast implants, are usually covered by insurance.
However, Alloderm (LifeCell) used as an adjunct to breast reconstruction is not always covered by insurance. In addition, LifeCell runs a service that specifically assists patients and physicians in obtaining coverage.
For patient and physician alike, the state-by-state regulations can be very complex to unravel.
For example, in Missouri, where I practice, the Missouri Revised Statute, Chapter 376, Life, Health and Accident Insurance, Section 376.1209, indicates the following guidelines for mastectomy patients:
“Mandatory insurance coverage for prosthetic devices and reconstructive surgery—no time limit to be imposed.”
To take another example, the state of Connecticut’s similarly worded statute—Chapter 700C of the Health Insurance Act, Section 38a-504c—shall “provide benefits for the reasonable costs of reconstructive surgery on each breast on which a mastectomy has been performed, and reconstructive surgery on a nondiseased breast to produce a symmetrical appearance … For the purposes of this subsection, reconstructive surgery includes, but is not limited to, augmentation mammoplasty, reduction mammoplasty and mastopexy.”
Not all state coverage is equal. Missouri actually has one of the more comprehensive policies.
In Connecticut, the regulations will not specifically prohibit an insurance company from denying a patient the renewal of their coverage due to a history of breast cancer or previous breast reconstruction.
The State of Missouri does not allow insurances covered under ERISA and WHRCA to deny a patient renewal based on previous cancer treatment.
WHAT DO THEY COVER?
Revisional procedures are somewhat less straightforward. Most insurance companies will cover revision of implant breast reconstruction for documentation of a leaking implant.
In addition, insurance companies often cover the treatment of capsular contracture. However, there are fewer consensuses among insurance companies for “cosmetic” revision of a breast reconstruction. This would include procedures performed because of asymmetry caused by weight gain or loss or malposition of an implant (too high or too low).
Very few plans cover the removal of implants for autoimmune disease or patient’s fears concerning breast implants, because there is no data supporting any link between silicone implants and any systemic disease.
Congenital breast asymmetry is a “gray area” regarding insurance coverage. Most plans will only consider coverage for congenital asymmetry for a diagnosis of Poland’s Syndrome.
Alternatives to Implant Coverage
Allergan Inc and Mentor Corp offer warranty programs covering reoperation for rupture within 10 years of the implant’s placement. Each firm’s plan varies; upgrades to higher coverage are available.
Each company offers automatic enrollment at no cost to the patient for silicone and saline breast implants, and the terms cannot be cancelled.
The Allergan ConfidencePlus Warranty offers lifetime replacement of a ruptured Allergan implant, and up to $1,200 in coverage for out-of-pocket expenses for operating room and anesthesia costs for replacement surgery (not covered by insurance).
For a one-time $100 payment, Allergan also offers additional coverage—up to $2,400 in financial assistance.
Allergan currently offers a no-cost warranty for all silicone gel implants.
Mentor offers an optional extended limited warranty, the Mentor Enhanced Advantage, which is above and beyond the protection offered by the standard Mentor Advantage program.
The benefits include operating room, anesthesia, and surgical charges not covered by insurance. As with Allergan’s coverage plan, the term is for 10 years and up to $2,400 in financial assistance.
This optional limited warranty is available with both saline-filled and silicone-filled breast implant products. To be eligible, patients must enroll within 45 days of implantation for a $100 fee.
Some plastic surgeons use CosmetAssure, an insurance plan that covers medical complications of aesthetic procedures that occur in the first 30 days following surgery.
This includes infection, bleeding, DVT, and pulmonary embolus that the patient’s medical insurance may not cover.
The entire list of covered complications is posted on the firm’s Web site. The surgeon must use the insurance on all of his or her aesthetic patients at a cost of $150 to $200 per procedure, depending on the geographical region.
As with all insurance policies, CosmetAssure enforces certain limitations, but the service can be useful if an unexpected complication occurs that requires hospitalization or revisional surgery.
The insurance does not cover surgery due to unacceptable aesthetic results or a patient’s desire to have a larger or smaller implant size, or to correct an asymmetry.
No matter what the coverage or company, you should inform patients about all benefits and limitations.
None of the plans cover reoperation to correct capsular contracture or aesthetically unacceptable results. Plastic surgeons may or may not charge patients for reoperation.
You should provide patients with a written description of your policy, in advance of surgery, so that you can avoid any confusion on this important point.
Some will consider coverage associated with pectus excavatum deformity, and a few will consider unilateral breast reduction if the patient meets the company’s criteria for breast reduction. This coverage is variable and needs to be predetermined for each case.
Will Insurance Cover Breast Augmentation For Asymmetry
Having one breast that is larger, smaller, or shaped differently from the other is a common condition for women. While it’s not life-threatening, it can cause feelings of insecurity and self-consciousness. Fortunately, there are surgical options available to correct breast asymmetry. However, there are some important things you should know before having surgery to correct your breasts:
Breast asymmetry is a common condition
Breast asymmetry is a common condition. It’s not a medical condition, but rather a cosmetic one. Breast asymmetry can be caused by genetics, breast feeding, or weight fluctuations.
If you’ve always had uneven breasts and are looking to fix it with surgery (which will be covered by insurance), then Insurance will cover breast augmentation surgery if both of your breasts are smaller than average in size and shape. This means that if one breast is larger than average while the other is smaller than average then this would not be considered an eligible candidate for insurance coverage because both breasts are within normal range on their own so there wouldn’t be any improvement in the appearance of either side once they’re enlarged together into one symmetrical pair!
Breast asymmetry is an issue for many women
Breast asymmetry is a common condition. The causes of breast asymmetry are many and varied, but it can be corrected with surgery if you have the right insurance coverage.
If your insurance company does not pay for breast augmentation to correct asymmetry, you may want to consider looking into other financing options such as CareCredit or financing through your plastic surgeon’s office.
Asymmetrical breast issues can be corrected through augmentation
If you have asymmetrical breasts, breast augmentation can help. Breast implants don’t worsen asymmetry and they can be used to correct it. Although there is no guarantee that your breasts will be perfectly symmetrical after the procedure, most women are happy with their results.
If you’re considering getting breast implants to correct your asymmetry, keep in mind that this is a safe procedure and there are many options available for achieving natural-looking results with minimal scarring or downtime. Your surgeon will also be able to tell you how long recovery will take so that you can plan accordingly before going back to work or school after surgery!
Not all insurance companies will cover surgery to correct asymmetrical breasts
Not all insurance companies will cover surgery to correct asymmetrical breasts. If you do not have a clear understanding of your insurance company’s policy on breast augmentation, it is important that you check with them before committing to a procedure.
The only way to know if your insurance company will pay for a breast augmentation to correct asymmetry is to contact them.
The only way to know if your insurance company will pay for a breast augmentation to correct asymmetry is to contact them.
You need to find out what your insurance covers, if you are eligible for coverage, what your responsibilities are and what the costs will be. You also need to ask about restrictions on certain procedures or types of care.
If you are seeking a breast augmentation to correct asymmetry, the first step is to reach out to your insurance company and find out what they will cover and what your responsibilities will be.
If you are seeking a breast augmentation to correct asymmetry, the first step is to reach out to your insurance company and find out what they will cover and what your responsibilities will be.
You may need to pay out of pocket, or you may be able to get a discount if your doctor has been pre-approved by their provider network. If you have a high deductible plan and would like more information about how this might affect your financial responsibility for this procedure, give us a call!
how to get insurance to pay for breast reduction
If you are reading this article, you are likely considering breast reduction. It has become more and more common to consider a breast reduction procedure. There are many reasons that women consider breast reduction which can include post-childbirth changes or that your breasts have become so large that they are hindering everyday activities such as exercising. A breast reduction procedure that can benefit you in many ways.
Many women wonder if your insurance benefits cover a breast reduction surgery. If you are asking yourself, “does insurance cover breast reduction?” you are not alone. Our office is asked this question frequently and we work hard to ensure that our patients know all of their options and exactly what their insurance company will provide and what they will not cover.
There are Many Reasons You May Be Considering Getting Your Breast Reduction Covered by Insurance
Unlike many places on our body, it is often very difficult to lose weight in the breasts. It has become a bit of a catch 22. For example, many women seeking to lose weight can perform all the cardio exercise that they can, while still not losing weight in their breasts. However, having extremely large breasts can also lead to pain when performing cardio exercise such as running, leading to a hindrance to do so, hence the catch 22.
If you are considering breast reduction surgery cost may be an issue when considering the procedure. However, what many women don’t know is that there are important factors that are considered when you are trying to get a breast reduction surgery through your insurance company. This is ideal for women who truly struggle with having breasts that are interfering with their everyday life and activities.
If you are considering having your breast reduction covered by insurance, here are a few different important points that can help make your case for a breast reduction covered by insurance.
See a Chiropractor or Physical Therapist for Neck and Back Pain
For many women, one of the reasons they are considering having breast reduction surgery in the first place is due to back pain, neck pain, shoulder pain, or just general stress on the back area. The first step is typically to visit a physical therapist or chiropractor in order to have your specific pain looked at. During your visit make sure you mention that you are considering a breast reduction surgery to alleviate your pain. Ask them to make a specific note on your patient file documenting your symptoms of pain and discomfort. These visits will show them that your symptoms are truly causing you pain and that you have made additional attempts to remedy them prior to going the route of surgery.
Meet with Your Primary Care Physician
When looking to get a breast reduction covered by insurance, it is important to meet with your primary care physician to discuss your symptoms from dense heavy breast tissue. A primary care physician will document the pain you are having and go over the long-term effects of neck and back pain. Don’t forget to include minor pains like being uncomfortable due to pain from bra straps digging in deeply. This will give you another example to show that you have a real physical problem and are not just seeking a cosmetic breast reduction surgery.
Meet with a Plastic Surgeon
Meet with a plastic surgeon, specifically one that specializes in breast reduction surgeries. A consultation will demonstrate that you are being proactive in gathering information to help make the best informed decision regarding a surgical procedure. A plastic surgeon will be able to write a letter of medical necessity which will highlight the important history of neck and back pain along with the treatments and recommendations of your other doctors. A plastic surgeon will include as part of that letter the number of grams to be removed from each breast that is an important parameter for the insurance company to review as part of the pre operative authorization process.
Insurance companies may require pre operative photographs as part of the pre authorization process for a breast reduction procedure. As part of the insurance pre authorization each insurance company will let the physicians office know if photographs are required.
Note Specific Activities That Are Affected by Your Breast Size and Pain Caused
These can also include physical symptoms, such as being uncomfortable sitting at work all day with your bra straps digging sharply into your shoulders. While these are not medical proof you need back pain, it gives insurance company a better idea of why you should have breast reduction surgery insurance covered.
A breast reduction surgery can have many great benefits and help you live a more confident, active lifestyle. A plastic surgeon who performs breast reduction surgery on a regular basis will work diligently with you to get your insurance company to cover the procedure. As long as your insurance company receives all of the medical necessity and pre operative information regarding your case they will likely approve the procedure. Most insurance companies just want to make sure your surgery is not being performed for cosmetic reasons.
how to get insurance to pay for plastic surgery
The question of whether plastic surgery is covered by insurance depends on the details of your insurance policy. Generally, cosmetic plastic surgery is not covered by insurance, but medically necessary or reconstructive plastic surgery is more likely covered.
This can change depending on the policy. But most insurance companies will not choose to cover the costs of elective, cosmetic surgery. Knowing what plastic surgery is covered by insurance requires understanding the different types of plastic surgery available.
Who Pays for Plastic Surgery?
Whether insurance will pay for plastic surgery depends on which insurance company you use, the type of coverage you have and the exact type of procedure you want to get.
Most insurance companies divide plastic surgery into procedures that are cosmetic, reconstructive or medically essential to preserve body function or quality of life, according to The Balance.
Here are some different procedures by category where typically plastic surgery is covered by insurance.
Reconstructive Surgery
According to the American Society of Plastic Surgeons (ASPS), reconstructive surgery is “performed to treat structures of the body affected aesthetically or functionally by congenital defects, developmental abnormalities, trauma, infection, tumors or disease.”
Such procedures are done to improve the function and abilities of the patient, although it may also be done to “achieve a more typical appearance of the affected structure,” according to the ASPS.
Cosmetic surgery
Unfortunately, most cosmetic surgery is not covered by health insurance plans. This is despite the fact that the amount of plastic surgery has increased 538% for women and 325% for men since 1997, according to the American Society for Aesthetic Plastic Surgery.
Insurance can vary from company to company and policy to policy, so it’s important to know the details of what your policy says.
congenital breast deformity
There are several congenital breast abnormalities which may result in breast under-development, asymmetry or unusual shaped breasts. It is also not uncommon to have mammary tissue or extra nipples in abnormal locations or, more rarely, a complete absence of breast tissue. Typically, these conditions become apparent in adolescence but can be diagnosed at any age.
Tuberous breast anomaly is a common congenital condition that is named for the typically elongated or tubular appearance of affected breasts, however, it can present in a variety of ways. Many women are unaware of the condition until consulting with a specialist, and are relieved to find there is an explanation for their breast asymmetry or unusual shaped breasts. Many patients seeking breast augmentation surgery have tuberous breast anomaly, and it’s recognition avoids potential pitfalls in surgical planning.
Typical characteristics associated with tuberous breasts include asymmetry, abnormally wide cleavage, a higher than normal inframammary fold (the crease formed by the fold under the breast), and large puffy areola due to a herniation of the breast tissue into the areola complex. Tuberous breasts will often have a narrow, conical “constricted” appearance, but may also display under development of one or more quadrants of one or both breasts. Presentation varies from mild abnormalities to more severe, and will differ between individuals and often between breasts in the same person.
Poland’s syndrome is a congenital anomaly of the chest wall which can result in absence of part of the pectoralis muscles, rib and breast tissue. This is often not noticeable in childhood but may become apparent when the breast on the affected side does not grow at the same rate as the normal side.
Polythelia is the term for supranumerary (extra) nipples or areolae. It can occur in up to 5% of the population and is sometimes misdiagnosed as other skin lesions. Polymastia is the development of accessory breast tissue, most common in the armpit (axilla) but can be anywhere on the body. This often only becomes apparent after hormonal changes in puberty or during lactation
If you believe your breasts display the characteristics of a congenital breast abnormality and it is something you would like to discuss, one of our plastic surgeons would be pleased to meet with you. At the initial consultation you will learn about options for management appropriate to your individual situation. Breast surgery to correctly and safely reconstruct congenital breast abnormality is often not just a straightforward breast augmentation. There are many factors to consider in order to safely and correctly achieve desired aesthetic results. Our specialist plastic surgeons have the skills and techniques to plan each patient’s surgical journey uniquely, catering to your individual needs.
We’re all about you, your journey, your way.
Further Information
The Procedure + Surgical Techniques
There are a variety of methods that can be used to correct congenital breast abnormalities, and it is sometimes necessary for these to be performed in stages. Your plastic surgeon will work with you to develop a surgical approach that will best achieve the aesthetic result you are after. Find comfort in knowing our surgeons are skilled in the latest techniques and applications for all breast surgery.
Breast surgery to correct congenital breast abnormalities is highly individual. It may require removing or rearranging some of the existing breast tissue, or augmenting an under-developed breast. The surgical correction of congenital breast abnormalities can be quite complex. For example, in tuberous or under-developed breasts, surgery may involve a two-stage approach. Tuberous breasts typically have a short distance between the breast fold and the nipple. Using a temporary device called a tissue expander in the first of a two stage correction, permits the skin of the lower part of the breast to slowly stretch out. This minimises stretch marks and provides balance to the breast by adding volume back to the area that is missing. A two stage procedure also gives patients some autonomy over the size, shape, look and feel of their reconstruction. The final result can be then be planned, usually with an implant and/or fat grafting procedures. Some patients require a breast lift and/or an areola reduction in this operation to improve symmetry and balance.
Hospital Stay and Anaesthesia
For reasons of patient safety, the correction of congenital breast abnormalities is nearly always performed under a general anaesthetic with an anaesthetist present. Some small procedures may be done under local anaesthetic only. Surgery can take place as a day procedure, but in some instances an overnight stay is required. Your plastic surgeon will discuss this with you during your initial consultation.
Your Consultation
In order to keep your consultation as smooth and efficient as possible, we ask that you bring all relevant documentation with you on the day or send it in to our practice beforehand. This includes your referral letter (if applicable), Medicare card, private health insurance details, any third party or insurance information and any relevant scans such as x-ray or other radiology scans and reports.
During your initial consultation with one of our specialist plastic surgeons, you will have extensive opportunity to discuss expectations and desired results. You will also have the opportunity to ask any questions you may have about the procedure itself.
You will then meet with one of our experienced breast care nurses, where you will have clinical images taken as a before and after reference for both yourself and your surgeon. All all our images are confidential and are stored securely online pursuant to the current Privacy Act. Your breast care nurse will take your measurements and fit you for a post-operative bra.
The final stage involves meeting with your surgeon’s personal assistant. You will be provided with an in-depth quote, including the fees for the surgeon, hospital and anaesthetist. When your surgery is booked, you will be given a pack which includes further details and instructions regarding your procedure.
We recommend that you allow an hour for the initial consultation. Please keep this in mind when organising parking so that you don’t feel the need to rush.
There is a lot of information to take in after your first consultation. We encourage our patients to go home and discuss their procedure with loved ones and come back for a second visit. We find many patients have additional questions and this second visit also allows you to discuss expectations for surgery and confirm the peri-operative plan, so you feel confident and fully informed about your procedure.
Before your procedure
There are a number of things you can start to implement before your procedure, to encourage a smooth recovery and ensure you are as comfortable as possible post-surgery. It is important that you:
Recovery
The time frame for recovery will vary depending on your procedure, your general health and fitness, and extent of surgery. Your return to work depends on the nature and physical exertion required for your job. Your surgeon will discuss this with you prior to surgery, and it is important to allow yourself the recommended recovery time. Vigorous activity and exercise should be avoided for the first six weeks, however gentle walking is encouraged after the first week.
On discharge, you will be given specific postoperative instructions to facilitate recovery, and a follow-up appointment will be made with your plastic surgeon. These instructions will cover everything you need to know in order to make your recovery as smooth and comfortable as possible.
Post-surgery it is common to have some bruising and swelling, as well as a feeling of tightness if you have an implant placed. This is perfectly normal, and while these issues typically subside within the first two weeks, they may persist for up to a month. Breathable tape dressings are applied across the incision lines, and these will remain until your first post-operative visit. You should be able to shower with these dressings on and pat them dry.
You may be required to wear your postoperative bra day and night for up to six weeks from the day of your surgery. The bra helps control the bruising and swelling, gives you support and helps reduce your pain. Patients often purchase two post-operative bras, to allow one to be laundered while the other is worn.
A plastic tube and collection bottle may remain post operatively to drain off excess fluid. These stay in place until the drainage slows and are removed by a nurse usually a day or two after your surgery. Most of the sutures used will be dissolvable, however any other sutures will be removed on day 10–14. Occasionally half your sutures are removed at this visit, and the other half are removed the following week.
Please be assured that our team is here to support you in making a swift, uncomplicated recovery. We offer a 24/7 on-call medical assistance service for all our post-operative patients.