Insurance Coverage for Breast Augmentation: 5 Surprising Facts You Need to Know

In general, insurance companies do not cover breast augmentation surgery for cosmetic purposes, as it is considered an elective procedure. However, there may be certain situations where insurance may cover the surgery, such as in cases where the surgery is deemed medically necessary, such as breast reconstruction after a mastectomy or for correction of a congenital breast deformity. It’s important to check with your insurance provider to determine what is covered under your specific plan.

In what circumstances would insurance companies consider breast augmentation surgery to be medically necessary and provide coverage for it?

These companies may consider breast augmentation surgery to be medically necessary and provide coverage for it in situations such as:

1. Breast reconstruction after a mastectomy due to breast cancer or other medical conditions.
2. Correction of a congenital breast deformity or developmental abnormality.
3. Treatment of breast asymmetry that causes significant physical or psychological distress.
4. Correction of breast ptosis (sagging) that causes functional problems, such as back or shoulder pain.
5. Treatment of gynecomastia (enlarged male breasts) that causes significant physical or psychological distress.

However, it’s important to note that coverage for breast augmentation surgery varies by insurance provider and plan, so it’s best to check with your insurance company to determine what is covered under your specific policy.

What steps should you take to determine if your insurance plan covers breast augmentation surgery?

If you’re considering breast augmentation surgery and want to determine if your insurance plan covers the procedure, here are some steps you can take:

1. Contact your insurance provider: Call the customer service number listed on your insurance card or visit the company’s website to find out what is covered under your specific policy.
2. Review your policy documents: Check your policy documents to see if breast augmentation surgery is explicitly listed as a covered benefit. If it is not, look for information about coverage for reconstructive surgery or other procedures related to breast health.
3. Get a referral from your doctor: If you have a medical condition that may require breast augmentation surgery, such as breast cancer or a congenital deformity, ask your doctor to provide a referral and any necessary documentation to support your case for insurance coverage.
4. Consider getting a pre-authorization: Some insurance plans require pre-authorization before certain procedures are covered. Ask your doctor if this is necessary for your breast augmentation surgery.
5. Check for exclusions or limitations: Even if breast augmentation surgery is covered under your plan, there may be exclusions or limitations that apply. For example, some plans may limit coverage to certain types of procedures or only cover a portion of the cost. Be sure to review your policy carefully to understand any limitations that may apply.

By taking these steps, you can better understand your insurance coverage and what you can expect to pay out of pocket for breast augmentation surgery.

Are there any additional costs that patients should be aware of when pursuing breast augmentation surgery through insurance coverage?

Yes, there may be additional costs that patients should be aware of when pursuing breast augmentation surgery through insurance coverage. Some of these costs may include:

1. Deductibles: Depending on your insurance plan, you may have to pay a deductible before your insurance coverage kicks in. This is a set amount that you have to pay out of pocket before your insurance starts covering the costs of your surgery.
2. Co-payments: Co-payments are a fixed amount that you have to pay out of pocket for each visit to the doctor or other healthcare provider. You may be required to pay a co-payment for your breast augmentation surgery, depending on your insurance plan.
3. Out-of-pocket expenses: Even if your insurance covers the majority of the cost of your breast augmentation surgery, you may still be responsible for paying some out-of-pocket expenses. These can include fees for the surgical facility, anesthesia, and other related costs.
4. Non-covered expenses: Your insurance may not cover all aspects of your breast augmentation surgery, such as the cost of implants or certain types of procedures. You may be responsible for paying these expenses out of pocket.
5. Additional procedures: Depending on your individual case, you may require additional procedures, such as a breast lift or reduction, in order to achieve the desired results of your breast augmentation surgery. These additional procedures may also incur additional costs.