Does Insurance Cover Breast Implant Surgery?

Will My Health Insurance Cover Breast Implant Surgery?

As the Detroit area’s top breast implant surgeon, we are often asked if breast implant surgery is covered by health insurance.

Typically, when surgery is purely an elective cosmetic procedure, insurance does not cover the cost of the surgery. However, in cases of “medical necessity” (such as reconstruction after breast cancer) insurance generally will cover breast implant surgery.

Additionally, a variety of financing options are available for those situations where insurance does not cover breast augmentation.

Insurance Coverage for Breast Reconstruction

Breast reconstruction procedures after a mastectomy or lumpectomy must be covered by your health insurance plan – according to The Women’s Health and Cancer Rights Act of 1998  – whether done right away, or many years later. This includes procedures done over time to refine the reconstructed breast or to create symmetry between both breasts.

Additionally, Medicare covers breast reconstruction, while Medicaid coverage can vary from state to state.

Also, if your breast implants were put in after a mastectomy and your doctor believes that removing your implants is “medically necessary,” then your health insurance is obligated by law to cover breast implant removal (Women’s Health and Cancer Rights Act of 1998 WHCRA).

Insurance Coverage for Complications from Breast Implant Surgery

Most health insurance policies expressly state that they will not cover “complications from cosmetic surgery” – but don’t give up yet.  Many health insurance policies have exceptions for complications from breast implants under certain circumstances that are considered “medically necessary” or “reconstructive surgery.”

What is “Medically Necessary”?

“Medically Necessary” is defined differently by different health insurance companies. Even if your doctor thinks removing your breast implants is medically necessary, your health insurance policy may still refuse to pay if their policy’s definition of medically necessary is different from your doctor’s.

Health insurance policies that cover subsequent complications of breast implants are usually based on one of the following conditions:

  • Silicone gel implants that have ruptured.
  • Silicone or saline implants that are causing capsular contracture.
  • Breast implants that are causing tissue necrosis.
  • Breast implants that need to be removed because of infection or cancer

Dr. Ali will discuss your insurance options with you, to see if any or all of your breast implant surgery may qualify for insurance coverage. Where insurance coverage is not available, our Detroit areaoffice can also offer you several convenient financing options.

The Detroit Area’s Best Breast Implant Surgery

Dr. Ali is a Detroit Area double board certified plastic surgeon, who has helped thousands of women get the breasts they want with breast implant surgery. He will offer you a consultation so you can understand what the best surgical options are for you. He will take the time to carefully answer all of your questions, and make sure that you have an understanding of the best techniques for achieving your appearance goals.

Detroit Area Breast Implant Surgery Consultation: 248-335-7200